| Description |
Aneurysm in the aortic area is occurred in dependence on arteriosclerosis and for the most part it is under the level of renal arteries. This is often found during routine investigations of the digestive tract. Some aneurysms grow very slowly for years. Effective postoperative solution shows relatively low mortality. 2-5%, unlike ruptured aneurysms whose mortality is between 50 to 70%. Also small aneurysms may rupture and become the cause of embolization into the periphery and in some cases to give rise to creation of aorto-caval fistulae. The algorithm of our procedure, if there exists a suspicion of AAA rupture, is as follows: if the patient has stable blood pressure over 90 mm Hg, the diagnosis may be corfirmed by computer tomography. Echo examination is unique for making of aneurysm diagnosis, however CT is better from the viewpoint of diagnostics of aneurysm rupture height. Because the ruptur is not palpable, CT is a big contribution but it would not block the patient in his/her prompt way to the operating theatre because this acute patient belongs there. The patients survival during these difficult surgical operations, affecting immunity, homeostasis, coagulation, hemodynamics depends on properly made and razant operation, and also on preoperative, operative, and particularly postoperative intensive therapy. Immediately after patients admission it is necessary to start the team cooperation without any delay to invasive intervention. The presentation evaluates the operational solution of aneurysms in the aorto-iliac area performed from 1989 through 2006 at the 2nd Department of Surgery in University Hospital in Brno. The elective solution is preferred. Ruptured abdominal aortic aneurysm (AAA) remains to be represent a common and highly lethal problem. We reviewed the records of 199 patients (160 men and 39 women) operated on for rutured infrarenal AAA within the past 18 years (January 1989 to December 2006) in the 2nd Department of Surgery in Brno, Czech Republic. The mean age was 71 years (range 57 to 92 years). Only 20 patients were known to have an AAA before the rupture. Preoperative systolic blood pressure below 90 mmHg. was prezent in 142 patients (71,36%) and 31 patients (15,58%) experienced cardiac arrest before surgery. The in-hospital mortality rate was 42,21 % (84 patients). Among the total of 199 patients, retroperitoneum was discovered only in 75 patients (37,69%) with the mortality rate of 29,33% (22 patients). In 124 patients (62,31%) also hemoperitoneum was prezent, the mortality rate was 50,00% (62 patients) in these patiens. Multiorgan failure due to an irreversible hemorragic shock was the main cause of death in 56 patients (52,83%). Further causes were: heart failure- 21 patients (19,81%), pulmonary complications- 12 patients (11,32%), renal failure- 11 patients ( 10,38%), bleeding- 5 patients (4,72%), and sepsis- 1 patient (0,94%). The patients prognosis depends on early diagnostics and on the duality of peroperative and postoperative care.
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