This study determines the early and late survival rates, the causes of death, and prognostic variables that are associated with early and late survival after for ruptured
abdominal aortic aneurysm (AAA). These are based on the prospective analysis of 628 variables of data on 158 consecutive patients in 24 centers of our association in 1989. Patients were followed up for a mean of 42.1 +/- 21.0 months. Six patients were lost to follow-up. To identify the variables that were associated with early and late survival, statistical methods included logistic regression analysis, Kaplan-Meier analysis, and Cox regression analysis. The survival rate was 52.9% +/- 14.4% at 1 month, 48.8% +/- 15.8% at 1 year, 48.1% +/- 16.0 at 2 years, 40.3 +/- 19.2% at 3 years, and 35.0 +/- 21.8 at 4 years. The cause of the 73 (46.2%) early deaths were cardiac (33),
hemorrhage (29), colonic
necrosis (5),
stroke (2), graft
infection (2),
pneumonia (1), and
kidney failure (1). Significant predictors of early death were the presence of a common
iliac aneurysm (p < 0.02), the age of the patient (p < 0.02), a previous history of
stroke or
transient ischemic attack (TIA) (p < 0.04), a bifurcated graft (p < 0.04), a
saccular aneurysm (p < 0.06), the blood
creatinine level (p < 0.06), and
hypotension on admission (p < 0.06). The causes of the 28 (17.7%) late deaths were
heart disease (11),
cancer (8),
stroke (3), another operation (3), graft
infection (1),
pneumonia (1), and
Alzheimer disease (1). Significant predictors of late death were heavy smoking (p < 0.03) and
chronic obstructive pulmonary disease (p < 0.07).
Rupture of an
abdominal aortic aneurysm remains a catastrophic event. Even after a successful cure of a ruptured AAA, cardiovascular causes of death are responsible for survival rates that are significantly lower than that in a matched nonaneurysmal population.