Troisi Nicola, Bertagna Giulia, Torri Lorenzo, Canovaro Francesco, D'Oria Mario, Adami Daniele, Berchiolli Raffaella
Vascular Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy.
Vascular Surgery Unit, Azienda Sanitaria Universitaria Giuliano Isontina, 34148 Trieste, Italy.
J Clin Med. 2023 Aug 25;12(17):5530. doi: 10.3390/jcm12175530.
despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment.
we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms' incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies.
the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention.
RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk-benefit assessment may improve outcomes.
尽管择期腹主动脉瘤的诊断和治疗有所改善，但破裂性腹主动脉瘤（RAAA）仍导致大量死亡。开放手术或血管腔内治疗方法的选择仍然是一个挑战，幸存者的术后并发症也是如此。本文的目的是概述RAAA患者的当代管理，重点关注术前和术中因素，这些因素可以帮助外科医生提供更合适的治疗。
我们在1985年1月1日至2023年5月1日期间对MEDLINE、Embase和Scopus进行了检索，并查阅了SVS和ESVS指南。共筛选出278篇文章，但只有那些提供了破裂性动脉瘤发病率和患病率、术前评分以及破裂性AAA急诊血管腔内修复或开放修复后死亡率数据的文章才被纳入叙述性综述。文章不受研究设计的限制。
RAAA的集中化改善了手术和血管腔内修复后的结果。术前死亡风险评分以及对影响死亡率的术中因素的了解有助于外科医生进行决策，尽管对于最佳治疗方法仍未达成共识。并发症仍然是干预后存活患者的一个问题。
RAAA仍然是一种危及生命的疾病，死亡率很高。有效的筛查和集中化，再加上充分的术前风险效益评估，可能会改善治疗结果。
