Ruptured abdominal aortic aneurysms

Abstract

The experience obtainel through 10 aneurisms of ruptured abdominal aorta which were operated upon, is reviewed. Operatory death rate is as high as 50 % , which is in agreement with the majority of world statistics so far presented. From the clinical point of view the shock factor is the most important with respect to prognosis. Two different groups of patients with this disease are presented to the surgeon: the first is formed by those arriving to the operation in stabilized cardio-circulatory conditions, having had a generally intense but temporary
shock a few hours or days before surgery; the other group is formed by those patients with a picture of severe and persistent shock who have to be operated upon in this condition. Survivals consist almost exclusively of patients in the first group. Quick clamping of the supra-aneurismatic aorta, with blood replacement at that moment -and not befare-
and the technique of "intra-sacular:• removal of aneurism, with its consequent saving of time and minimun disection, are factores which help to improve results in this extremely serious complication. Correct control of blood volume and adequate hydration, both in quantity and quality, are also important elements for prognosis. It is also fundamental that·
the patient be watched for at least 48 hours in an intensive treatment centre. Preoperatory aligo-anuria, intra-peritoneal hemorrhage and advanced age, are ominous signs for prognosis. The paper pres. ents one extremely rare case of simultaneous rupture of the inferior vena cava and of the retroperitoneum, which was operated successfully.