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eComment: Ruptured abdominal aortic aneurysms – endovascular treatment and hemodynamic parameters

University Hospital, 10000 Zagreb, Croatia

Preoperative haemodynamic parameters and the immediate outcome after open repair of ruptured abdominal aortic aneurysms

The authors clearly confirmed that patients with depressed cardiac function and suboptimal oxygen delivery preoperatively are at very high risk to die after surgery of ruptured abdominal aortic aneurysm (RAAA) [1]. Despite improvements in treatment algorithms, mortality of RAAA has remained constantly high over the last decades [2]. According to our results in a 10-year period (1999–2009), mortality rates of hemodynamically unstable patients with RAAA are up to 80%. This is in line with our observation in this high-risk subgroup of patients with RAAA. Additionally, preoperatively concomitant cardiac depression and profound hemodynamic changes aggravate diagnostic and therapeutic procedures. In our series, all deaths occurred during emergency surgery in the shock unit. The cause was ongoing blood loss due to aortic free rupture and complications related to cardiac impairment. In the management of hemodynamically RAAA, postponed intervention due to treatment of additional cardiac-life threatening lesions seems to be an advantage. Minor bleeding of the RAAA has a benign course, and preoperative plan for a surgical approach following imaging is valuable. Controversially, major ruptures have an insidious course and require prompt intervention. Until 2000, in our institution, these patients have been treated conventionally by tubular or bifurcated replacement graft or with endovascular (EVAR) technique of the ruptured aortic segment. Over time, EVAR stent-graft placement has evolved as a safe and effective treatment modality for RAAA. As initial results have been encouraging, this new treatment modality has been used more liberally and short-term as well as mid-term results are well documented [3]. Especially in high-risk patients, who are frail and have a diminished physiologic reserve, this minimally invasive technique does not expose these patients to substantial risk.

According to our results in a 10-year period with EVAR, we concluded that preoperative hemodynamic stability, cardiac function as well as a straightforward individual treatment strategy are prerequisites for survival of RAAA. Endovascular stent-graft placement has emerged as an innovative and minimally invasive surgical option in high-risk patients with RAAA, but early postoperative results, in our opinion, are strongly related with perioperative optimization of cardiac function and oxyhemodynamic parameters. The authors suggest similar conclusions, and for this reason, I would like to encourage their future work on this topic.

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1. Giordano S, Biancari F, Loponen P, Wistbacka JO, Luther M. Preoperative hemodynamic parameters and the immediate outcome after open repair of ruptured abdominal aortic aneurysms. Interact CardioVasc Thorac Surg 2009;9:491–493.[Abstract/Free Full Text]
2. Laukontaus SJ, Pattilä V, Kantonen I, Salo JA, Ohinmaa A, Lepäntalo M. Utility of surgery for ruptured abdominal aortic aneurysm. Ann Vasc Surg 2006;20:42–48.[CrossRef][Medline]
3. Treska V, Certik B, Cechura M, Novak M. Ruptured abdominal aortic aneurysms – university center experience. Interact CardioVasc Thorac Surg 2006;5:721–723.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Narcis Hudorovic Permission Requests Google Scholar Articles by Hudorovic, N. PubMed PubMed Citation Articles by Hudorovic, N. Related Collections Related Article