Damage Control in the Management of Ruptured Abdominal Aortic Aneurysm: Preliminary Results

• Published in: Vascular and endovascular surgery 2010-11, Vol.44 (8), p.638-644
• Main Authors: Tadlock, Matthew D., Sise, Michael J., Riccoboni, Steven T., Sise, C. Beth, Sack, Daniel I., Sise, Robert G., Yang, Jack C., Borut, Jeffrey J., King, Bryan S.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - physiopathology; Aortic Aneurysm, Abdominal - surgery; Aortic Aneurysm, Abdominal - therapy; Aortic Rupture - mortality; Aortic Rupture - physiopathology; Aortic Rupture - surgery; Aortic Rupture - therapy; Biological and medical sciences; Blood and lymphatic vessels; Blood Component Transfusion; Blood Loss, Surgical - prevention & control; Blood Pressure; Cardiology. Vascular system; Chi-Square Distribution; Diseases of the aorta; England; Female; Humans; Isotonic Solutions - administration & dosage; Male; Medical sciences; Middle Aged; Outcome and Process Assessment (Health Care); Pilot Projects; Resuscitation - adverse effects; Resuscitation - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality
• ISSN: 1538-5744; 1938-9116
• DOI: 10.1177/1538574410375132

Background: This study compared damage control measures (DCM), including operative techniques (DCO) and resuscitative measures (DCR), with standard treatment (ST) for ruptured abdominal aortic aneurysm (rAAA). Methods: Historical cohort study methodology was used to evaluate outcomes for rAAA repairs related to DCM or ST over a 74-month period at a level I trauma center. Results: Of 28 repairs, 13 (46.4%) were DCM. Compared to ST patients, DCM patients had a lower mean preoperative BP (64.6 vs. 83.2 mm Hg, P = .03) and greater intraoperative blood loss (4.6 vs. 2.1 liters, P = .033). Patients who had both DCR and DCO (DCO & DCR) received more plasma (6.8 vs 2.6 units, P = .039) and less crystalloid (2.8 vs 10.5 liters, P = .005) than those receiving DCO only. A modest decrease in mortality was seen in the DCO & DCR group compared to DCO only. No DCO-related graft infections were observed. Conclusion: DCR use may prove beneficial in the management of rAAA.