3.11 Ruptured AAA

Question 1

Decision to operate on a ruptured AAA

Answer 1

1. Consultant Anaesthetist
2. Consultant general surgeon
3. Consultant vascular surgeon in nearest centre
4. Patient - if have capacity
   and their NOK unable to consent
   Lack capacity - may be poor prognostic indicator

Question 2

Perioperative factors a/w Good + Bad outcomes

Good

Answer 2

Preop Creat <130 mmol/L

Evidence of Good Urine output

Presence of InfraRenal aneurysm
(vs supra / juxta renal)

Lack of comorb CVS

Question 3

Bad Outcome

Answer 3

Preop comorb
RF / IHD / COPD

Intraperitoneal Rupture

Persistent preop hypotension
SBP <90

Evidence of Mutli organ complications

Hardman study

Question 4

Hardman study

Answer 4

retrospective study w/ 5 variables poor outcome

1) >76
2) Ischaemic ECG
3) Creat >190
4) Low GCS
5) Hb <9g/dL

> 3 - a/w 100% mortality

Question 5

If decision to operate

prep of patient prior to transfer

Answer 5

1 May not worse outcome in some
Some remain stable for a period post leak

Clinical Issues

• SBP 90-95mmHg (judicious fluid)
• Avoid HTN and complete rupture

Invasive monitoring
Wide bore access mandatory prior to tranfer

Pre drawn up vasoactives
prior to transfer

Question 6

Investigation

+ Accompany

Answer 6

FBC U+E Clotting X match blood

Copies of same
ECGs Scans XRAYS

Appropriate medical personnel