Stroke and Myocardial Infraction in the Survivors of Ruptured Abdominal Aortic Aneurysm
Terri-Ann Russell, Maher Hamish, Gabor Libertiny.
Northampton General Hospital, Northampton, United Kingdom.
OBJECTIVES: The aim of this study is to establish the incidence of major cerebro-vascular and cardio-vascular events in patients who survived operative intervention post ruptured Abdominal Aortic Aneurysm (rAAA). The secondary outcome is to establish how age correlates to surviving a rAAA. METHODS: Data of the patients who had a rAAA over a 6 year period that was operated on at a single vascular centre was obtained from a national database . To obtain information on major cardiac or cerebro-vascular events we assessed the discharge summaries, correspondence as well as imaging and biochemical results during that admission looking specifically for indicators of these complications such as positive troponin levels to indicate a cardiovascular event and a CT brain confirming a cerebro-vascular accident with documentation of a persistently new neurological deficit. RESULTS: Over 6-year period 96 patients had an operative intervention for a rAAA. 92 patients had open abdominal aortic aneurysm repair (OR) while 4 patients had endovascular aortic aneurysm repair (EVAR). The average age in this cohort of patient was 74.2 years. The average aneurysm size is 79.9 mm. Of the patients that had repair 53 (55%) survived to discharge. 23 (43%)patients in this study were in their 8th decade of life and beyond. Of this group, there was a 30.4% survival to discharge. 15 patients were </= 65 years of age, of this subset of patients the survival was 86.6%. Of the patients that survived, 23 (43%) had a complication post operatively of which respiratory,renal impairment and ischaemic colitis were the highest. Only 3 (5.7%) patients had a myocardial infarction, all of which had percutaneous coronary intervention. Only one patient had a CVA (1.9%) which was after a PEA arrest which was secondary to hypoxia. CONCLUSIONS: : Surviving the catastrophe of a rAAA is associated with significant morbidity with a significant number of patient having temporary or permanent single organ dysfunction hence resulting in a prolonged post-operative course. In this series the patients who survive however, the likelihood of major cerebro and cardiovascular event is low ( 6% & 2%) and is quite close to that of elective repair. As expected the younger the patient the higher the likelihood of surviving these insults.
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