Analysis of High-Risk Factors and Mortality Prediction of Ruptured Abdominal Aortic Aneurysm

Introduction

Ruptured abdominal aortic aneurysms (RAAAs) are among the most dangerous emergencies in vascular surgery, with a high death rate and numerous risk factors influencing perioperative death. Therefore, identifying the critical risk factors for RAAAs is crucial to increasing their survival rate. Our aim was to identify those risk factors from a wide range of parameters.

Methods

Retrospective analysis of hospitalized RAAA patients treated at this center between May 2004 and January 2023. After comparing the preoperative data of patients who survived and those who died, high-risk characteristics influencing the perioperative care of RAAA patients were identified, and logistic regression analysis was carried out. The mean follow-up time was 45.34 months.

Results

During the study period, a total of 155 patients (average age 67.4 ± 71.93 years, 123 (78.85%) males, 32 (20.51%) females) were enrolled. The patients participating in the group were divided into survival group (n = 123) and death group (n = 27). The main differences included hemodynamic instability (51.9% vs 28.5%; P = 0.019), sudden cardiac arrest (14.8% vs 1.6%; P = 0.010), deterioration of consciousness (40.7% vs 17.1%; P = 0.007), renal impairment (22.2% vs 2.4%; P = 0.001), and chronic kidney disease (18.5% vs3.2%; P = 0.010). There is also a history of cancer (Ca) (18.5% vs 4.1%; P = 0.021). Risk factors for endovascular aneurysm repair (EVAR) include diastolic blood pressure ≤50 mm Hg (36.4% vs 8.0%; P = 0.025), renal function impairment (18.2% vs 0; P = 0.015), and chronic kidney disease (27.3% vs 4.0%; P = 0.028). Risk factors for open surgical repair (OSR) include diastolic blood pressure ≤50 mm Hg (40.0% vs 6.3%; P = 0.014). Finally, the previously mentioned statistically significant factors were analyzed by logistic regression analysis, and it was found that diastolic blood pressure ≤50 mm Hg, cardiac arrest, renal function damage, and Ca history were independent risk factors. We followed 123 individuals and 14 were lost to follow-up, with an overall survival rate of 43.8%.

Conclusions

Hemodynamics, which includes shock, blood pressure, cardiac arrest, deterioration of consciousness, and other conditions, are the primary risk factors for the perioperative death of a ruptured abdominal aortic aneurysm. Simultaneously, diastolic blood pressure ≤50 mm Hg was found to be associated with risk factors for OSR, whereas renal function impairment, chronic renal illness, and diastolic blood pressure ≤50 mm Hg were associated with the risk for EVAR.