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The open-first strategy is acceptable for ruptured abdominal aortic aneurysm even in the endovascular era

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Abstract

Purpose

To examine the surgical findings of ruptured abdominal aortic aneurysm (RAAA) based on the open-first strategy in the last decade, and to analyze the predictors of in-hospital mortality for RAAA in the endovascular era.

Methods

The subjects of this retrospective study were 116 patients who underwent RAAA repair, for whom sufficient data were available [25% female, median age 76 (70–85) years]. Sixteen (13.8%) patients were managed with endovascular aneurysm repair (EVAR) and 100 patients (86.2%) were managed with open surgical repair (OSR).

Results

Univariate analysis identified base excess (BE) (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.79–0.96; p = 0.006), and preoperative cardiopulmonary arrest (CPA) [OR] 15.4; 95% [CI] 1.30–181; p = 0.030), BE (OR 0.88; 95% CI 0.79–0.96; p = 0.006), shock index (OR 2.44; 95% CI 1.01–5.94; p = 0.050), lactic acid (Lac) (OR 1.18; 95% CI 1.02–1.36; p = 0.026), and blood sugar (BS) > 215 (OR 3.46; 95% CI 1.10–10.9; p = 0.034) as positive predictors of hospital mortality.

Conclusions

The findings of this study suggest that a first-line strategy of OSR for ruptured AAAs is acceptable. Poor preoperative conditions, including a high shock index, CPA, low BE, high Lac, and a BS level > 215 mg/dl, were identified as predictors of hospital mortality, rather than the procedures themselves.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka, 564-8565, Japan

    Yoshimasa Seike, Koki Yokawa, Shigeki Koizumi, Kento Shinzato, Mio Kasai, Kenta Masada, Yosuke Inoue, Hiroaki Sasaki & Hitoshi Matsuda

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  1. Yoshimasa Seike
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  2. Koki Yokawa
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  3. Shigeki Koizumi
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  4. Kento Shinzato
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  5. Mio Kasai
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  6. Kenta Masada
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  7. Yosuke Inoue
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  8. Hiroaki Sasaki
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  9. Hitoshi Matsuda
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Correspondence to Hitoshi Matsuda.

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Seike, Y., Yokawa, K., Koizumi, S. et al. The open-first strategy is acceptable for ruptured abdominal aortic aneurysm even in the endovascular era. Surg Today 54, 138–144 (2024). https://doi.org/10.1007/s00595-023-02709-6

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  • DOI: https://doi.org/10.1007/s00595-023-02709-6

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