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Abdominal aortic aneurysms: results of emergency surgery 

Abdominal aortic aneurysms: results of emergency surgery
Chapter:
Abdominal aortic aneurysms: results of emergency surgery
Author(s):

Alan Karthikesalingam

and Peter Holt

DOI:
10.1093/med/9780199658220.003.0052
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date: 22 September 2019

Ruptured abdominal aortic aneurysms (AAAs) represent the endpoint of aneurysmal disease. Patients often present in extremis with hypotension and collapse. The mortality of ruptured aneurysms remains around 80% with only half of patients reaching hospital alive. Recent improvements in outcome have been primarily due to improvements in intensive care provision. Randomised trials suggest that an “endovascular repair-first” strategy is equivalent to open repair in terms of 1-year mortality, but EVAR for rAAA is associated with better quality of life and more rapid discharge from hospital. Subgroup analysis of the IMPROVE trial showed that aneurysm morphology is an important determinant of outcome from both EVAR and open repair, with short-necked rAAA faring poorly in both groups. The effect of patient transfer and the role of permissive hypotension on subsequent survival remain the focus of clinical research.

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