Prehospital Treatment of Infrarenal Ruptured Abdominal Aortic Aneurysms: A Multicentric Analysis

Simon Rinckenbach, Jean Noel Albertini, Fabien Thaveau, Eric Steinmetz, Amélie Camin, Lionel Ohanessian, François Monassier, Claude Clément, Roger Brenot, Gabriel Camelot, Nabil Chakfé, Jean Georges Kretz

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Background: The aim of this study was to evaluate the quality of the current treatment of patients presenting with ruptured abdominal aortic aneurysms (RAAAs), from the first symptoms to the operating room with an analysis of preoperative mortality risk factors. Methods: For 3 years, in four vascular surgery departments, we have collected all the consecutive cases of patients operated on for RAAA. We analyzed the initial clinical situation, the means of transportation, the time elapsed before treatment, and the mortality rate at 3 days. Sixty-six RAAAs were operated on. Mean patient age was 76 years (range, 52-93 years). Results: The initial symptoms were a precisely located pain either abdominal (45.3%), lumbar (17.2%), or both (14.1%) or feeling faint (10.9%). In 22.7% of the cases, an initial hemodynamic instability was observed. In 46.8% of the cases, patients first went to a peripheral hospital before being admitted into a referral centre. In 84.5% of the cases, medical mean of transportation was used. The mean distance covered was 59.8 kilometers (range, <5 km to 213 km). The initial diagnosis was accurate in 67.3% of the cases. The mean intrahospital waiting period between the arrival at a reference center and the admission into an operating room was 127 minutes. Global mortality rate was 44.2%. The main preoperative mortality factor to be noticed was the initial hemodynamic instability (p = 0.0031). Among stable patients, only two of them (5.4%) worsened during the preoperative treatment. Conclusion: In our study, hemodynamic instability corresponds to the main prognosis factor of mortality. In most cases, the initial stability persisted and allowed additional evaluation. However, the intrahospital waiting periods appeared to be too long. To be optimal, the adequate treatment should be specifically designed as soon as a diagnosis has been established.

Original languageEnglish (US)
Pages (from-to)308-314
Number of pages7
JournalAnnals of Vascular Surgery
Volume24
Issue number3
DOIs
StatePublished - Apr 2010

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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