Ruptured abdominal aortic aneurysm: a 25-year experience and analysis of recent cases.

An 8-year experience with treatment of 58 patients with ruptured abdominal aortic aneurysm (RAAA) is reviewed with hospital mortality of 25.9 per cent. Added to a previously reported experience, 115 patients have been treated over 25 years with 33 per cent mortality. Preoperative hypotension, free rupture, venous injury, and massive transfusion were found to be associated with mortality. Interhospital transfer, preexisting coronary or pulmonary disease, known aneurysm, anemia, delay in surgery, and operative time were not found to predict outcome. Some patients are normotensive at presentation, providing an excellent chance for survival when expeditious diagnosis and treatment are carried out. Optimal operative management, complications, and causes of death are discussed. The role of computed tomography (CT) in diagnosis is considered. Elective resection of known aneurysms is the most important factor in reducing deaths from RAAA. The role of regionalization of care is unclear, since some patients cannot be safely transported. However, some evidence for optimal results in specialized centers is presented.