Changing trends in the outcome of urgent aneurysms surgery. A retrospective study on 170 patients treated in the years 1966-1990.

During the last 25 years 170 patients with ruptured aortic aneurysms were treated in our centre for vascular surgery with an overall mortality of 54%. We have subdivided these patients into three groups according to temporal factors: the 1st group includes 16 patients treated in the years 1966-1978; the 2nd group includes 93 patients treated from 1979 to 1987; the 3rd group includes patients from 1988 to 1990. In these years no selection of patients was made and everybody still alive was operated on. Starting from the second period, haemodynamical monitoring of the patients was performed with the adoption of the Swan-Ganz catheter in almost all cases. Mortality in the first period was 69%, in the second period 60% and in the third period 40%. There was no difference in the haemodynamical state in the three groups. The difference lies in the number of surgical interventions per year: 1.33 intervention per year in the first period; 11.625 interventions per year in the second period and 20 in the third. We conclude that an improvement in the survival rate of patients undergoing urgent aortic aneurysm repair is due to precise haemodynamical intraoperative monitoring and a well trained surgical team.