Current therapy of ruptured abdominal aortic aneurysms

Ruptured abdominal aortic aneurysms (rAAA) still represent a vascular emergency with hemorrhagic shock and high perioperative mortality. Preclinical evaluation requires a rapid consideration of various differential diagnoses, straightforward diagnostic procedures and immediate treatment in specialized centres. Open surgical repair still remains the gold standard for treating ruptured abdominal aortic aneurysm. The mainstays of standard therapy consist of immediate bleeding control by open surgical aortic clamping or endovascular balloon occlusion, aneurysma exclusion by implantation of a tube or bifurcated alloplastic prosthesis. Endovascular aortic repair by implantation of bifurcated or aortomonoiliac stent grafts is increasingly being used in selected patients with suitable aortic configuration in an attempt to improve patient survival. For patients with ruptured abdominal aortic aneurysms endovascular aortic repair has become a new minimally invasive treatment option even in patients with severe comorbidities, although the data reported so far are not yet conclusive enough and long term results are missing. Perioperative therapy requires treatment of multiorgan failure following hemorrhagic shock and ischemia reperfusion damage by fluid administration, coagulation support, maintenance of normothermia and awareness of intestinal ischemia and abdominal compression syndrome. © 2009 Springer Medizin Verlag.