Hypotensive Hemostasis in Patients Presenting with Ruptured Aortic Aneurysm

  • Felice Pecoraro
  • Bernard Krüger
  • Johnny Steuer
  • Neal Cayne
  • Zoran Rancic
  • Frank J. Veith
  • Mario LachatEmail author


Hypotensive hemostasis in aortic rupture has been showed to be feasible and advantageous, especially in trauma patients. To date, there are no randomized studies on hypotensive hemostasis in patients with ruptured abdominal aortic aneurysm (rAAA), but observational studies indicate similar advantages when hypotensive hemostasis is used for endovascular aneurysm repair (EVAR) as in trauma patients. Actually, in EVAR for rAAA, a target systolic blood pressure of 90 mmHg or even lower is considered safe in conscious patients. Fluids should be administrated judiciously with the sole aim of maintaining adequate cardiac output and tissue oxygenation, whereas vasoactive pressors or dilatators may be used to adjust systolic blood pressure in hypertension or severe hypotension. Local anesthesia maintains stable hemodynamics and should therefore be employed wherever possible in the treatment of patients presenting with rAAA or blunt aortic injuries.


Abdominal Aortic Aneurysm Abdominal Compartment Syndrome Endovascular Aneurysm Repair Control Hypotension Maintain Blood Pressure 
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  1. 1.
    Morrison CA, Carrick MM, Norman MA, Scott BG, Welsh FJ, Tsai P, et al. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J Trauma. 2011;70(3):652–63.CrossRefPubMedGoogle Scholar
  2. 2.
    Bougle A, Harrois A, Duranteau J. Resuscitative strategies in traumatic hemorrhagic shock. Ann Intensive Care. 2013;3(1):1.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Mayer D, Rancic Z, Veith FJ, Pecoraro F, Pfammatter T, Lachat M. How to diagnose and treat abdominal compartment syndrome after endovascular and open repair of ruptured abdominal aortic aneurysms. J Cardiovasc Surg. 2014;55(2):179–92.Google Scholar
  4. 4.
    Vlaar AP, Hofstra JJ, Determann RM, Veelo DP, Paulus F, Kulik W, et al. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case–control study. Blood. 2011;117(16):4218–25.CrossRefPubMedGoogle Scholar
  5. 5.
    Andresen AF. Management of gastric hemorrhage. Modern Med. 1949;17(20):72–5.Google Scholar
  6. 6.
    Akins CW, Buckley MJ, Daggett W, McIlduff JB, Austen WG. Acute traumatic disruption of the thoracic aorta: a ten-year experience. Ann Thorac Surg. 1981;31(4):305–9.CrossRefPubMedGoogle Scholar
  7. 7.
    Crawford ES. Ruptured abdominal aortic aneurysm. J Vasc Surg. 1991;13(2):348–50.CrossRefPubMedGoogle Scholar
  8. 8.
    Veith FJ, Ohki T. Endovascular approaches to ruptured infrarenal aorto-iliac aneurysms. J Cardiovasc Surg. 2002;43(3):369–78.Google Scholar
  9. 9.
    Yilmaz N, Peppelenbosch N, Cuypers PW, Tielbeek AV, Duijm LE, Buth J. Emergency treatment of symptomatic or ruptured abdominal aortic aneurysms: the role of endovascular repair. J Endovasc Ther. An Official Journal of the International Society of Endovascular Specialists. 2002;9(4):449–57.Google Scholar
  10. 10.
    van der Vliet JA, van Aalst DL, Schultze Kool LJ, Wever JJ, Blankensteijn JD. Hypotensive hemostatis (permissive hypotension) for ruptured abdominal aortic aneurysm: are we really in control? Vascular. 2007;15(4):197–200.CrossRefPubMedGoogle Scholar
  11. 11.
    Cothren CC, Moore EE, Hedegaard HB, Meng K. Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg. 2007;31(7):1507–11.CrossRefPubMedGoogle Scholar
  12. 12.
    Perel P, Roberts I. Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2011(3):CD000567Google Scholar
  13. 13.
    Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med. 2008;36(1):296–327.CrossRefPubMedGoogle Scholar
  14. 14.
    Kaye P, O'Sullivan I. Myocardial contusion: emergency investigation and diagnosis. Emerg Med J. 2002;19(1):8–10.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hoey BA, Schwab CW. Damage control surgery. Scand J Surg. SJS Official organ for the Finnish Surgical Society and the Scandinavian Surgical Society. 2002;91(1):92–103.Google Scholar
  16. 16.
    Shaftan GW, Chiu CJ, Dennis C, Harris B. Fundamentals of physiologic control of arterial hemorrhage. Surgery. 1965;58(5):851–6.PubMedGoogle Scholar
  17. 17.
    Kozek-Langenecker SA, Afshari A, Albaladejo P, Santullano CA, De Robertis E, Filipescu DC, et al. Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. Eur J Anaesthesiol. 2013;30(6):270–382.CrossRefPubMedGoogle Scholar
  18. 18.
    Bettex DA, Lachat M, Pfammatter T, Schmidlin D, Turina MI, Schmid ER. To compare general, epidural and local anaesthesia for endovascular aneurysm repair (EVAR). Eur J Vasc Endovasc Surg. The Official Journal of the European Society for Vascular Surgery. 2001;21(2):179–84.Google Scholar
  19. 19.
    Lachat ML, Pfammatter T, Witzke HJ, Bettex D, Kunzli A, Wolfensberger U, et al. Endovascular repair with bifurcated stent-grafts under local anaesthesia to improve outcome of ruptured aortoiliac aneurysms. Eur J Vasc Endovasc Surg. The Official Journal of the European Society for Vascular Surgery. 2002;23(6):528–36.Google Scholar
  20. 20.
    Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, et al. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery. Eur J Vasc Endovasc Surg. The Official Journal of the European Society for Vascular Surgery. 2011;41 Suppl 1:S1–58.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Felice Pecoraro
    • 1
    • 2
  • Bernard Krüger
    • 3
  • Johnny Steuer
    • 1
    • 4
  • Neal Cayne
    • 5
  • Zoran Rancic
    • 1
  • Frank J. Veith
    • 1
    • 5
  • Mario Lachat
    • 1
    Email author
  1. 1.Clinic for Cardiovascular SurgeryUniversity HospitalZurichSwitzerland
  2. 2.Institute for Cardiovascular AnesthesiaUniversity HospitalZurichSwitzerland
  3. 3.Vascular Surgery UnitUniversity of Palermo, University Hospital ‘P. Giaccone’PalermoItaly
  4. 4.Department of Surgery, Section for Vascular SurgerySouth HospitalStockholmSweden
  5. 5.New York University Medical CenterNew YorkUSA

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