[Ruptured aneurysm of the abdominal aorta and iliac arteries. An analysis of 132 cases].

A series of 132 consecutive patients with ruptured aneurysms of the abdominal aorta or iliac arteries treated between 1979 and 1984 is retrospectively reviewed. 13% had a known abdominal aneurysm before rupture. Workup consisted of clinical assessment alone in 69%, assisted by ultrasound in 23%. Perioperative mortality was 35% (70%-confidence limits (CL) 30%-39%). Preoperative factors associated with increased mortality were age over 80 years, shock and evidence of coronary artery disease. In addition, intraoperative blood transfusion over 10 liters, suprarenal site of rupture, presence of free intraperitoneal blood, suprarenal aortic clamping and operation lasting longer than 3.5 hours were related to death, though higher mortality was statistically significant only for operating time and site of clamping. Cardiac morbidity was the most common and most critical factor affecting 52% of patients with a mortality of 59% (CL: 52%-65%). Development of oligo-anuric renal failure in postoperative course was almost uniformly associated with death (91%, CL: 83%-96%) even with use of dialysis, usually from multiple systems failure. Actuarial five-year survival, including perioperative mortality, was 38% (CL: 33%-43%). After a mean follow up of 3.3 years 82% (CL: 76%-87%) of surviving patients are in good health comparable to the pre-rupture state. Although many risk factors exist there are few contraindications to surgery, and results can be improved if workup and operation are rapid and simple. Minimizing blood loss is essential, while supportive measures in postoperative multiple systems failure still remain a serious problem. Prevention of rupture by resection of the intact aneurysm remains the ultimate goal.