Surgical Strategy for Ruptured Abdominal Aortic Aneurysms in Cases of Severe Shock

DOI 2 Citations 19 References
  • Morikage Noriyasu
    Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
  • Onoda Masahiko
    Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
  • Nomura Shinji
    Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
  • Yoshimura Koichi
    Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
  • Furutani Akira
    Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine
  • Hamano Kimikazu
    Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine

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  • 破裂性腹部大動脈瘤の予後向上策<br>─Rutherford分類レベル 3，4 の重症ショック症例に対する治療戦略─

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Background:We previously reported that a Rutherford classification level 3 or 4 (R3, R4) was a prognostic factor correlating with survival after repair of a ruptured abdominal aortic aneurysm (RAAA). In this study, we describe our surgical strategy and clinical results for R3 and R4 level patients. Methods: RAAA repair was performed in 48 cases from 1996 to 2007, including 18 cases in the first period (1996 to 2000) and 30 cases in the second period (2001 to 2007). R3 and R4 levels were detected in 6 cases in the first period and in 14 cases in the second period. In R3 and R4 level patients, who are in severe shock, we evaluated postoperative complications, hospital mortality rate, and cause of death. Descending thoracic aortic cross-clamping for immediate recovery from severe shock state and temporary abdominal closure for prevention of abdominal compartment syndrome (ACS) were performed as surgical strategy R3 and R4 level patients in the second period. Of those 14 cases, 9 (64.3%) underwent descending thoracic aortic cross-clamping. Twelve cases (85.7%) underwent temporary abdominal closure, of which the first two cases underwent abdominal wall closure of the skin only without fascial closure, followed by two cases of closure with latex, and two cases using the vacuum-assisted closure (VAC) technique on latex. The 6 most recent cases underwent closure by the VAC technique only. Results: The rate of incidence of postoperative bowel necrosis and renal failure were significantly lower in the second period than in the first period (0% vs. 50%, P=0.007, 0% vs. 66.7%, P=0.001, respectively). The hospital mortality rate of R3 and R4 patients was significantly reduced in the second period than in the first period (14.3% vs. 66.7%, P=0.019). The causes of death in cases of R3 and R4 were low cardiac output syndrome (LOS) (n=2) and multiple organ failure (n=2) in the first period. LOS (n=2) was the only cause of death in the second period. Conclusion: Our results suggest that the surgical strategies of descending thoracic aortic cross-clamping for immediate recovery from severe shock state and temporary abdominal closure for prevention of ACS are effective in improving the outcome in of patients with RAAA in a state of severe shock.

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