Zusammenfassung
Im Zeitraum von 1993 bis 2000 wurden 85 Patienten wegen Ruptur eines abdominellen Aortenaneurysma (AAA) behandelt. Das mittlere Alter betrug 72,4 Jahre (46-90). In 71 Fällen handelte es sich um eine infrarenale Ruptur, in 14 Fällen um eine suprarenale Ruptur. Das Aneurysma trat in 76 Fällen als gedeckte Ruptur auf. Alle Patienten wurden operiert. Die operative Versorgung erfolgte 43-mal mit einer Linearprothese, 31-mal mit einer Bifurkationsprothese. In 2 Fällen musste wegen eines mykotischen Aneurysmas ein Aortenverschluss mit extraanatomischer Umleitung erfolgen. Bei 11 Patienten konnte die Operation nicht beendet werden. 21 Patienten verstarben postoperativ im Krankenhaus. Hingegen wurde die Aneurysmaruptur von 53 Patienten überlebt. Die Letalitätsrate betrug 37,6 %. Im postoperativen Verlauf imponierten nichtchirurgische Frühkomplikationen. Die Letalitätsrate wurde maßgeblich beeinflusst durch die respiratorische-, Nieren- und Herzinsuffizienz. Welche Patienten eine Aortenruptur überleben, kann im Notfall nicht vorhergesehen werden. Der Versuch einer Rekonstruktion sollte deshalb bei jedem Patienten unternommen werden.
Abstract
During 1993 to 2000 85 patients were treated for a ruptured abdominal aortic aneurysm. The average age of the patients was 72.4 years (46-90). 71 patients showed an infrarenal rupture and the remaining 14 a suprenal rupture. 76 of 85 cases were covered ruptures. All patients were operated upon. A tube graft was required in 43 cases and 31 needed a bifurcated graft. In further two cases an extraanatomical bypass was necessary due to a mycotic aneurysm. The operation on 11 patients could not be completed and 21 patients died in hospital during the postoperative period. On the other hand, 53 patients suvived the rupture of the aneurysm. The mortality rate was 37.6 %. The early non-surgical complications dominated during the postoperative period. Respiratory failure, renal failure and cardiac failure were responsible for the mortality rate. It is unforseeable which patients will survive the emergency operation. Therefore it is always appropriate to attempt the reconstruction of an acutely ruptured AAA.
Schlüsselwörter
Rupturiertes abdominelles Aortenaneurysma - Therapeutische Strategie - Ergebnisse - Komplikationen
Key words
Ruptured abdominal aortic aneurysm - therapeutic strategies - results - complications
Literatur
-
1
Akkersdijk G J, van der Graaf Y, van Bockel J H, de Vries A C, Eikelboom B C.
Mortality rates associated with operative treatment of infrarenal abdominal aortic aneurysm in The Netherlands.
Br J Surg.
1994;
81
706-709
-
2
Alonso-Perez M, Segura R J, Pita S, Cal L.
Surgical treatment of ruptured aortic aneurysms in the elderly.
J Vasc Surg.
1999;
13
592-598
-
3
Bengtsson H, Bergqvist D.
Ruptured abdominal aortic aneurysm: a population-based study.
J Vasc Surg.
1993;
18
74-80
-
4
Bjorck M, Bergqvist D, Troeng T.
Incidence and clinical presentation of bowel ischaemia after aortoiliac surgery - 2 930 operations from a population-based registry in Sweden.
Eur J Vasc Endovasc Surg.
1996;
12
139-144
-
5
Bickerstaff L K, Hollier L H, Van Peenen H J, Melton L J, Pairolero P C, Cherry K J.
Abdominal aortic aneurysms: the changing natural history.
J Vasc Surg.
1984;
1
6-12
-
6
Cooley D A, De Bakey M E.
Ruptured aneurysm of the abdominal aorta. Excision and homograft replacement.
Postgrad Med.
1954;
16
334-343
-
7
Crawford E S, De Bakey, Cooley D A.
Surgical correlations of aneurysms and artherosclerotic occlusive lesions of the aorta and major arteries.
Postgrad Med.
1961;
29
151-159
-
8
Fanti L, Masci E, Mariani A, Chiesa R, Jannello A, Melissano G, Castellano R, Guerini S, Tittobello A.
Is endoscopy useful for early diagnosis of ischaemic colitis after aortic surgery? Results of a prospective trial.
Ital J Gastroenterol Hepatol.
1997;
29
357-360
-
9
Gosselin C, Labbe R, Douville Y, Noel H P.
Ruptured abdominal aortic aneurysm: long-term survival.
Ann Chir.
1991;
45
774-777
-
10
Hallin A, Bergqist D, Holmberg L.
Literature review of surgical treatment of abdominal aortic aneurysm.
Eur J Vasc Surg.
2001;
3
197-204
-
11
Halpern V J, Kline R G, D'Angelo A J, Cohen J R.
Factors that affect the survival rate of patients with ruptured abdominal aortic aneurysms.
J Vasc Surg.
1997;
26
939-945; discussion 945-948
-
12
Haug E S, Myhre H O, Saether O D, Stromholm T, Nordang E, Aadahl P.
Results after surgical treatment of abdominal aortic aneurysm.
Tidsskr Nord Laegeforen.
1996;
116
493-496
-
13
Hoffmann M, Avellon J C, Plecha F R, Rhodes R S.
Operation for ruptured abdominal aortic aneurysms: a community-wide experience.
Surgery.
1982;
91
597-602
-
14
Hsiang Y N, Turnbull R G, Nicholls S C, McCullough K, Chen J C, Lokanathan R, Taylor D C.
Predicting death from ruptured abdominal aortic aneurysms.
Am J Surg.
2001;
181
30-35
-
15
Imig H, Schroder A.
Aorto-iliac artery aneurysm.
Chirurg.
1990;
61
155-162
-
16
Johansen K, Kohler T R, Nicholls S C, Zierler R E, Clowes A W, Kazmers A.
Ruptured abdominal aortic aneurysm: the Harborview experience.
J Vasc Surg.
1991;
13
240-245
-
17
Johnston K W.
Nonruptured abdominal aortic aneurysm: six-year follow-up results from the multicenter prospective Canadian aneurysm study. Canadian Society for Vascular Surgery Aneurysm Study Group.
J Vasc Surg.
1994;
20
163-170
-
18
Kaiser M M, Wenk H, Sassen R, Muller G, Bruch H P.
Ischemic colitis after vascular surgery reconstruction of an abdominal aortic aneurysm.
Chirurg.
1996;
67
380-386
-
19
Katz D J, Stanley J C, Zelenock G B.
Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: an eleven-year statewide experience.
J Vasc Surg.
1994;
19
804-815; discussion 816-817
-
20
Kazmers A, Perkins A J, Jacobs L A.
Aneurysm rupture is independently associated with increased late mortality in those surviving abdominal aortic aneurysm repair.
J Surg Res.
2001;
95
50-53
-
21
Kirsch D, Rechenberg A, Böttger T, Junginger T.
Long-term outcome after reconstructive interventions of the aorto-iliac segment.
Langenbecks Arch Chir.
1997;
382
49-54
-
22
Kniemeyer H W, Kolvenbach R, Rohde E, Godehardt E, Sandmann W.
“Inflammatory aneurysm” of the aorta. Diagnosis, therapy, results.
Chirurg.
1990;
61
27-31
-
23
Kniemeyer H W, Kessler T, Reber P U, Ris H B, Hakki H, Widmer M K.
Treament of ruptured abdominal aortic aneurysm, a permanent challenge or a waste of resources? Prediction of outcome using a multi-organ-dysfunction score.
Eur J Vasc Surg.
2000;
19
190-196
-
24
Koskas F, Kieffer E.
Surgery for ruptured abdominal aortic aneurysm: early and late results of a prospective study by the AURC in 1989.
Ann Vasc Surg.
1997;
11
90-99
-
25
Lindholt J S, Henneberg E W, Fasting H, Juul S.
Mass or high-risk screening for abdominal aortic aneurysm.
Br J Surg.
1997;
84
40-42
-
26
Müller B T, Wegener O R, Grabitz K, Pillny M, Thomas L, Sandmann W.
Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases.
J Vasc Surg.
2001;
33
106-113
-
27
Nasim A, Sayers R D, Thompson M M, Healey P A, Bell P R.
Trends in abdominal aortic aneurysms: a 13 year review.
Eur J Vasc Endovasc Surg.
1995;
9
239-243
-
28
Noel A A, Gloviczki P, Cherry K J, Bower T C, Panneton J M, Mozes G I, Harmsen W S, Jenkins G D, Hallett J W.
Ruptured abdominal aortic aneurysms: the excessive mortality rate of conventional repair.
J Vasc Surg.
2001;
34
41-46
-
29
Pfeiffer T, Reiher L, Grabitz K, Sandmann W.
Ergebnisse der konventionellen Therapie des abdominellen Aortenaneurysmas seit Beginn der „endovasculären Ära”.
Chirurg.
2000;
71
72-79
-
30
Ritter R, Grabitz K, Godehardt E, Sandmann W.
Langzeitergebnisse nach Operation eines Bauchaortenaneurysmas im Alter über 80 Jahre.
Gefäßchirurgie.
1997;
2
5-10
-
31
Schildberg F W, Heiss M M.
Das rupturierte Aortenaneurysma als Überraschungsbefund der Laparotomie beim akuten Abdomen.
Chirurg.
1998;
69
28-37
-
32
Schmidt R, Bruns C, Walter M, Erasmi H.
Aorto-caval Fistula - an uncommon complication of infrarenal aortic aneurysms.
Thorac Cardiovasc Surg.
1994;
42
208-211
-
33
Semmens J B, Norman P E, Lawrence-Brown M M, Holman C D.
Influence of gender on outcome from ruptured abdominal aortic aneurysm.
Br J Surg.
2000;
87
191-194
-
34
van Dongen H P, Leusink J A, Moll F L, Brons F M, de Boer A.
Ruptured abdominal aortic aneurysms: factors influencing postoperative mortality and long-term survival.
Eur J Vasc Endovasc Surg.
1998;
15
62-66
-
35
Wen S W, Simunovic M, Williams J I, Johnston K W, Naylor C D.
Hospital volume, calendar age, and short term outcomes in patients undergoing repair of abdominal aortic aneurysms: the Ontario experience, 1988-92.
J Epidemiol Community Health.
1996;
50
207-213
OA Dr. U. Keßler
Klinik für Viszeral-, Thorax- und Gefäßchirurgie
Fetscherstraße 74
01307 Dresden
