Clinical Features of 544 Patients With Ruptured Aortic Aneurysm　- A Report From the Tokyo Acute Aortic Super Network Database.

Abstract

BACKGROUND:

Epidemiological data on ruptured aortic aneurysms from large-scale studies are scarce. The aims of this study were to: clarify the clinical course of ruptured aortic aneurysms; identify aneurysm site-specific therapies and outcomes; and determine the clinical course of patients receiving conservative therapy.Methods and Results: Using the Tokyo Acute Aortic Super Network database, we retrospectively analyzed 544 patients (mean [±SD] age 78±10 years; 70% male) with ruptured non-dissecting aortic aneurysms (AAs) after excluding those with impending rupture. Patient characteristics, status on admission, therapeutic strategy, and outcomes were evaluated. Shock or pulselessness on admission were observed in 45% of all patients. Conservative therapy, endovascular therapy (EVT), and open surgery (OS) accounted for 32%, 23%, and 42% of cases, respectively, with corresponding mortality rates of 93%, 30%, and 29%. The overall in-hospital mortality rate was 50%. The prevalence of pulselessness was highest (48%) in the ruptured ascending AA group, and in-hospital mortality was the highest (70%) in the ruptured thoracoabdominal AA group. Multivariable logistic regression analysis indicated in-hospital mortality was positively associated with pulselessness (odds ratio [OR] 10.12; 95% confidence interval [CI] 4.09-25.07), and negatively associated with invasive therapy (EVT and OS; OR 0.11; 95% CI 0.06-0.20).

CONCLUSIONS:

The outcomes of ruptured AAs remain poor; emergency invasive therapy is essential to save lives, although it remains challenging to reduce the risk of death.

• Authors: Koichi Akutsu, Hideaki Yoshino, Tomoki Shimokawa, Hitoshi Ogino, Takashi Kunihara, Toshiyuki Takahashi, Michio Usui, Kazuhiro Watanabe, Manabu Yamasaki, Takeshiro Fujii, Mitsuhiro Kawata, Yoshinori Watanabe, Takeshi Yamamoto, Shun Kohsaka, Ken Nagao, Morimasa Takayama
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) (Feb 28 2024) ISSN: 1347-4820 [Electronic] Japan
• PMID: 38417888 (Publication Type: Journal Article)