Scali Salvatore T, Stone David H
Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL, United States.
Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
Front Cardiovasc Med. 2023 Dec 12;10:1323465. doi: 10.3389/fcvm.2023.1323465. eCollection 2023.
Ruptured abdominal aortic aneurysms (rAAA) remain one of the most clinically challenging and technically complex emergencies in contemporary vascular surgery practice. Over the past 30 years, a variety of changes surrounding the treatment of rAAA have evolved including improvements in diagnosis, development of coordinated referral networks to transfer patients more efficiently to higher volume centers, deliberate de-escalation of pre-hospital resuscitation, modification of patient and procedure selection, implementation of clinical pathways, as well as enhanced awareness of certain high-impact postoperative complications. Despite these advances, current postoperative outcomes remain sobering since morbidity and mortality rates ranging from 25%-50% persist among modern published series. Some of the most impactful variation in rAAA management has been fostered by the rapid proliferation of endovascular repair (EVAR) along with service alignment at selected centers to improve timely revascularization. Indeed, clinical care pathways and emergency response networks are now increasingly utilized which has led to improved outcomes contemporaneously. Moreover, evolution in pre- and post-operative physiologic resuscitation has also contributed to observed improvements in rAAA outcomes. Due to different developments in care provision over time, the purpose of this review is to describe the modern management of rAAA, while providing historical perspectives on patient, procedure and systems-based practice elements that have evolved care delivery paradigms in this complex group of patients.
腹主动脉瘤破裂（rAAA）仍然是当代血管外科临床上面临挑战最大、技术上最复杂的急症之一。在过去30年里，围绕rAAA治疗发生了多种变化，包括诊断的改进、建立协调的转诊网络以更有效地将患者转运至高容量中心、有意降低院前复苏强度、调整患者和手术选择、实施临床路径以及提高对某些具有重大影响的术后并发症的认识。尽管有这些进展，但目前的术后结果仍然不容乐观，因为在现代发表的系列研究中，发病率和死亡率仍在25%至50%之间。血管内修复（EVAR）的迅速普及以及选定中心的服务调整以改善及时血运重建，推动了rAAA管理中一些最具影响力的变化。事实上，临床护理路径和应急响应网络现在越来越多地被使用，这同时带来了更好的结果。此外，术前和术后生理复苏的发展也促成了rAAA结果的改善。由于随着时间推移护理提供方面的不同发展，本综述的目的是描述rAAA的现代管理，同时提供关于患者、手术和基于系统的实践要素的历史观点，这些要素已经改变了这一复杂患者群体的护理模式。
