Ergebnisse und Komplikationen in der Behandlung des rupturierten abdominellen Aortenaneurysmas

 

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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.

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