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Rupturiertes Bauchaortenaneurysma

Perioperative Prädiktoren für den klinischen Verlauf nach konventioneller offener Behandlung

Ruptured abdominal aortic aneurysm

Perioperative indicators for the clinical course following conventional open surgery

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Teilergebnisse der Arbeit wurden als Poster mit dem Titel „Die offene operative Therapie des rupturierten Aneurysmas der Aorta abdominalis – Prädiktoren für das Überleben in den ersten 30 postoperativen Tagen“ Grotemeyer D, Strauß K, Balzer KM, Drabik A und Sandmann W auf dem 22. Jahreskongress der Deutschen Gesellschaft für Gefäßchirurgie, 6.–9. September 2006, Mülheim an der Ruhr und als Vortrag mit dem Titel „Rupturiertes AAA: Pro offene Operationen“ Weis-Müller BT, Strauß K, Grotemeyer D und Sandmann W beim 15. Gefäßchirurgisches Symposium 2006, Hotel Renaissance Hamburg, 20.–22. Januar 2006, vorgestellt.

Zusammenfassung

Hintergrund und Zielsetzung

Das rupturierte Bauchaortenaneurysma (rBAA) stellt nach wie vor eine lebensbedrohliche vaskuläre Erkrankung dar und ist trotz verbesserter Diagnostik und perioperativem Patientenmanagement mit einer hohen Sterblichkeit behaftet. Ziel der Studie war es, perioperative Prädiktoren nach offen-konventioneller Behandlung für das Überleben bzw. Versterben an einer Bauchaortenruptur zu ermittelt.

Patientenkollektiv und Methoden

Es wurden retrospektiv die Krankheits- und Behandlungsverläufe von 67 Patienten untersucht, die zwischen Januar 1985 und Dezember 2004 als Notfall an einem rupturierten Aneurysma der Aorta abdominalis in unserer Klinik operiert wurden. Insgesamt wurden 72 präoperative, 47 intraoperative und 39 postoperative Variablen erfasst und analysiert.

Ergebnisse

Patienten mit einem rBAA und einer prolongierten Schockphase, welche auf dem Boden der Mitbeteiligung der Beckengefäße eine Y-Prothese implantiert bekamen, hatten die prognostisch schlechteste Überlebenswahrscheinlichkeit. Eine Auswirkung des Alters sowie bestehender Begleiterkrankungen auf die Mortalität konnte nicht bewiesen werden. Bezüglich der Rupturlokalisation, peritoneal vs. retroperitoneal, konnte ebenfalls keine Einflussnahme auf den postoperativen Verlauf gezeigt werden. In dem hier untersuchen Patientenkollektiv betrug die kumulative Überlebensrate 30 Tage nach Operation 59,7% und für das 1. Jahr noch 43,3%.

Fazit

Anhand dieser Studie konnte gezeigt werden, dass weder ein fortgeschrittenes Lebensalter noch bestehende Begleiterkrankungen einen Einfluss auf die Mortalität bei Patienten mit einem rBAA haben. Dem entsprechend sollte bei Patienten mit rBAA keine aufwändige Selektion nach Vorerkrankungen erfolgen, sondern u. E. eine schnellstmögliche konventionell operativ chirurgische Ausschaltung durchgeführt werden, um somit eine Überlebenschance zu erreichen.

Abstract

Objectives

Ruptured abdominal aortic aneurysms (rAAA) still represent a life-threatening vascular disease, with high mortality despite improved diagnostic tools and perioperative patient management. The aim of this study was to reveal predictors of perioperative mortality and survival after open (conventional) rAAA repair.

Patients and Methods

We analyzed data from our department containing 67 patient histories and clinical notes which were collected between January 1984 and December 2004. The study patients underwent emergent surgery for rAAA. In these cases we defined 72 preoperative, 47 intraoperative, and 39 postoperative variables for further analysis.

Results

Our results indicate that the worst survival prognosis could be defined in patients with rAAA and aneurysmatic inclusion of the iliac arteries with concomitant prolonged shock who received an aorto-iliac bypass. For these patients we calculated a cumulative 30-day survival rate of 59.7% and 1-year survival of 43.3%. An influence of age and comorbidity on the mortality rate could not be proven. Furthermore the conclusion cannot be drawn that postoperative course was influenced by intra- vs retroperitoneal rupture localization.

Conclusion

This study provides evidence that neither old patient age nor comorbidities influence the mortality of patients suffering from rAAA, for whom time-consuming case selection according to previous morbidities should therefore be omitted. Instead we recommend conventional surgical repair as soon as possible to maximize the chances of survival.

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Authors and Affiliations

  1. Klinik für Gefäßchirurgie und Nierentransplantation, Universitätsklinikum der Heinrich-Heine-Universität, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    D. Grotemeyer, K. Strauß, B.T. Weis-Müller & W. Sandmann

  2. Institut für Statistik in der Medizin, Universitätsklinikum der Heinrich-Heine-Universität, Düsseldorf, Deutschland

    A. Drabik

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  1. D. Grotemeyer
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  2. K. Strauß
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  3. B.T. Weis-Müller
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  4. A. Drabik
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  5. W. Sandmann
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Correspondence to D. Grotemeyer.

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Grotemeyer, D., Strauß, K., Weis-Müller, B. et al. Rupturiertes Bauchaortenaneurysma. Chirurg 79, 745–752 (2008). https://doi.org/10.1007/s00104-008-1524-8

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