Johnson G, McDevitt N B, Proctor H J, Mandel S R, Peacock J B
Arch Surg. 1980 Jan;115(1):51-3. doi: 10.1001/archsurg.1980.01380010043008.
The patient with the symptomatic abdominal aortic aneurysm (AAA) presents a management dilemma, ie, emergent, urgent, or elective operation. The mortality for 38 patients with a ruptured AAA prior to 1972 was 61%. That year, a policy of immediate operation was instituted for patients with symptoms that might be referable to a ruptured AAA. It is concluded that an immediate operation on the patient with a symptomatic but intact AAA resulted in an excessively high mortality. Thus, the indications for an immediate operation on these patients should be based on clinical judgment; attempting to differentiate between the patient with the ruptured and the patient with the intact aneurysm. Hemodynamic data (blood pressure hematocrit reading) suggesting a decrease in blood volume dictate an immediate operation. An urgent operation on the well-prepared patient should be performed on all patients with a symptomatic aneurysm in which the clinical and hemodynamic findings do not suggest that it has ruptured.
有症状的腹主动脉瘤（AAA）患者面临治疗困境，即急诊、限期或择期手术。1972年前，38例AAA破裂患者的死亡率为61%。同年，针对可能由AAA破裂引起症状的患者制定了立即手术的政策。得出的结论是，对有症状但未破裂的AAA患者立即进行手术会导致过高的死亡率。因此，对这些患者立即进行手术的指征应基于临床判断；试图区分动脉瘤破裂患者和未破裂患者。提示血容量减少的血流动力学数据（血压、血细胞比容读数）表明需要立即手术。对于所有有症状的动脉瘤患者，若临床和血流动力学检查结果未提示动脉瘤已破裂，应对准备充分的患者进行限期手术。
