PMID- 29481927
OWN - NLM
STAT- MEDLINE
DCOM- 20181003
LR  - 20181004
IS  - 1615-5947 (Electronic)
IS  - 0890-5096 (Linking)
VI  - 49
DP  - 2018 May
TI  - Who Should Be Operated When Presenting with a Ruptured Abdominal Aortic Aneurysm? 
      A Monocentric Study in a Tertiary Hospital.
PG  - 158-163
LID - S0890-5096(18)30156-0 [pii]
LID - 10.1016/j.avsg.2017.10.040 [doi]
AB  - BACKGROUND: Mortality with ruptured abdominal aortic aneurysms (rAAAs) is 80% 
      overall, 50% when operated, and 100% when not operated. Distinguishing in 
      emergency patients who should be operated versus being offered palliative 
      treatment is difficult. We sought to identify key factors to consider in this 
      decision-making. METHODS: Between 2001 and 2014, we selected all consecutive 
      patients with rAAA treated by open or endovascular procedures in a tertiary 
      hospital for inclusion in this retrospective, single-center study. Symptomatic 
      aneurysms and isolated ruptured iliac aneurysms were excluded. The primary 
      outcome was in-hospital mortality, and secondary outcomes were 
      institutionalization rate and long-term mortality. Associations between 
      predictive factors and in-hospital mortality were evaluated using univariate 
      logistic regression. The local ethics committee approved this study. RESULTS: The 
      mean age (+/-standard deviation) of the 72 included patients was 73 years (+/-9.0) 
      and 88% were men. Among the 65 open (90%) and 7 endovascular procedures (10%), 
      overall in-hospital mortality was 21%, 1- and 2-year mortalities were both 26%, 
      and the institutionalization rate was 5%. Mean follow-up was 43 months 
      (Kaplan-Meier estimate). Univariate analysis identified age as associated with a 
      20% per year increased risk of in-hospital mortality (correlation, P < 0.0001). 
      Female sex was the other main preoperative risk factor correlated with 
      in-hospital mortality (P = 0.006). Significant perioperative risk factors were 
      suprarenal clamping (P = 0.038), amount of fresh frozen plasma transfused 
      (P = 0.018), and number of blood transfusions (P < 0.0001). CONCLUSIONS: The most 
      significant preoperative mortality-related factors were age and female sex. Our 
      study also showed that institutionalization and long-term mortality are not 
      factors to consider in the decision-making process.
CI  - Copyright (c) 2018 Elsevier Inc. All rights reserved.
FAU - Holzer, Thomas
AU  - Holzer T
AD  - Clinique des Grangettes, Chenes-Bougeries, Switzerland. Electronic address: 
      thomas.holzer@grangettes.ch.
FAU - Deglise, Sebastien
AU  - Deglise S
AD  - CHUV, Service de Chirurgie Vasculaire, Lausanne, Switzerland.
FAU - Ballabeni, Pierre
AU  - Ballabeni P
AD  - CHUV, Service de Chirurgie Vasculaire, Lausanne, Switzerland.
FAU - Corpataux, Jean-Marc
AU  - Corpataux JM
AD  - CHUV, Service de Chirurgie Vasculaire, Lausanne, Switzerland.
FAU - Saucy, Francois
AU  - Saucy F
AD  - CHUV, Service de Chirurgie Vasculaire, Lausanne, Switzerland.
LA  - eng
PT  - Journal Article
DEP - 20180223
PL  - Netherlands
TA  - Ann Vasc Surg
JT  - Annals of vascular surgery
JID - 8703941
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Aneurysm, Abdominal/diagnostic imaging/mortality/*surgery
MH  - Aortic Rupture/diagnostic imaging/mortality/*surgery
MH  - *Clinical Decision-Making
MH  - Decision Support Techniques
MH  - Female
MH  - Hospital Mortality
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Logistic Models
MH  - Male
MH  - Middle Aged
MH  - Odds Ratio
MH  - *Patient Selection
MH  - Predictive Value of Tests
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Sex Factors
MH  - Switzerland
MH  - *Tertiary Care Centers
MH  - Time Factors
MH  - Treatment Outcome
MH  - *Vascular Surgical Procedures/adverse effects/mortality
EDAT- 2018/02/27 06:00
MHDA- 2018/10/04 06:00
CRDT- 2018/02/27 06:00
PHST- 2017/08/24 00:00 [received]
PHST- 2017/10/16 00:00 [revised]
PHST- 2017/10/24 00:00 [accepted]
PHST- 2018/02/27 06:00 [pubmed]
PHST- 2018/10/04 06:00 [medline]
PHST- 2018/02/27 06:00 [entrez]
AID - S0890-5096(18)30156-0 [pii]
AID - 10.1016/j.avsg.2017.10.040 [doi]
PST - ppublish
SO  - Ann Vasc Surg. 2018 May;49:158-163. doi: 10.1016/j.avsg.2017.10.040. Epub 2018 
      Feb 23.