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Review
. 2023 Aug 25;12(17):5530.
doi: 10.3390/jcm12175530.

The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge

Nicola Troisi  1 , Giulia Bertagna  1 , Lorenzo Torri  1 , Francesco Canovaro  1 , Mario D'Oria  2 , Daniele Adami  1 , Raffaella Berchiolli  1
Affiliations
Review

The Management of Ruptured Abdominal Aortic Aneurysms: An Ongoing Challenge

Nicola Troisi et al. J Clin Med. .

Abstract

Background: despite improvements in the diagnosis and treatment of elective AAAs, ruptured abdominal aortic aneurysms (RAAAs) continue to cause a substantial number of deaths. The choice between an open or endovascular approach remains a challenge, as does postoperative complications in survivors. The aim of this manuscript is to offer an overview of the contemporary management of RAAA patients, with a focus on preoperative and intraoperative factors that could help surgeons provide more appropriate treatment.

Methods: we performed a search on MEDLINE, Embase, and Scopus from 1 January 1985 to 1 May 2023 and reviewed SVS and ESVS guidelines. A total of 278 articles were screened, but only those with data available on ruptured aneurysms' incidence and prevalence, preoperative scores, and mortality rates after emergency endovascular or open repair for ruptured AAA were included in the narrative synthesis. Articles were not restricted due to the designs of the studies.

Results: the centralization of RAAAs has improved outcomes after both surgical and endovascular repair. Preoperative mortality risk scores and knowledge of intraoperative factors influencing mortality could help surgeons with decision-making, although there is still no consensus about the best treatment. Complications continue to be an issue in patients surviving intervention.

Conclusions: RAAA still represents a life-threatening condition, with high mortality rates. Effective screening and centralization matched with adequate preoperative risk-benefit assessment may improve outcomes.

Keywords: endovascular repair; high-volume center; open surgical repair; preoperative scores; ruptured abdominal aortic aneurysm.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart.
Figure 2
Figure 2
The flow chart summarizes the centralization process.
Figure 3
Figure 3
(a) CTA shows a postero-lateral AAA rupture with retroperitoneal hematoma. (b) The picture shows an open surgical repair of an RAAA with vertebral exposure (black arrow). CTA, Computed Tomography Angiography; AAA, abdominal aortic aneurysm; RAAA, ruptured abdominal aortic aneurysm.
See this image and copyright information in PMC

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