Ruptured abdominal aortic aneurysms
Aneurismas rotos de la aorta abdominal
Resumen:
The experience obtainel through 10 aneurisms of ruptured abdominal aorta which were operated upon, is reviewed. Operatory death rate is as high as 50 % , which is in agreement with the majority of world statistics so far presented. From the clinical point of view the shock factor is the most important with respect to prognosis. Two different groups of patients with this disease are presented to the surgeon: the first is formed by those arriving to the operation in stabilized cardio-circulatory conditions, having had a generally intense but temporaryshock a few hours or days before surgery; the other group is formed by those patients with a picture of severe and persistent shock who have to be operated upon in this condition. Survivals consist almost exclusively of patients in the first group. Quick clamping of the supra-aneurismatic aorta, with blood replacement at that moment -and not befare-and the technique of "intra-sacular:• removal of aneurism, with its consequent saving of time and minimun disection, are factores which help to improve results in this extremely serious complication. Correct control of blood volume and adequate hydration, both in quantity and quality, are also important elements for prognosis. It is also fundamental that·the patient be watched for at least 48 hours in an intensive treatment centre. Preoperatory aligo-anuria, intra-peritoneal hemorrhage and advanced age, are ominous signs for prognosis. The paper pres. ents one extremely rare case of simultaneous rupture of the inferior vena cava and of the retroperitoneum, which was operated successfully.
Se analiza una experiencia de 10 aneurismas de la aorta abdominal rotos operados. La mortalidad operatoria asciende al 50 % , cifra que concuerda con la mayoría de las estadísticas mundiales presentadas hasta el momento actual. Desde el punto de. vista clínico el factor shock es el más importante con respecto al pronóstico. Dosgrupos distintos de pacientes con esta afección se presentan al cirujano: el primero, lo constituyen los que. llegan al acto quirúrgico en condiciones cardiocirculatoriasestabilizadas y que han tenido un episodio de colapso circulatorio, generalmente intenso, pero pasajero, unas horas o días antes de la operación; el otro grupo lo forman aquellos enfermos con cuadro de shock severo y persistente y que en esas condiciones deben ser intervenidos. Los sobrevivientes integran casi exclusivamente el primer grupo.El clampeo rápido de la aorta supraaneurismática, con reposición sanguínea en este momento y no antes, y la técnica de extirpación "intra-sacular" del aneurisma, con el consiguiente ahorro de tiempo y disección mínima, son factores que contribuyen a mejorar los resultados e.n esta gravísima complicación. El correcto reemplazamiento de la volemia y laadecuada hidratación, en cantidad y calidad, son también importantes elementos de pronóstico. La necesidad de una vigilancia, por lo menos de 48 horas, en un centro de tratamiento intensivo, es asimismo fundamental. La presencia de oligoanuria, preoperatoria, de hemorragia intraperitoneal, y una avanzada edad, son signos ominosos de pronóstico.Se relata un caso, sumamente infrecuente, de rotura simultánea en vena cava inferior y retroperitoneo, operado exitosamente.
1972 | |
cirugía cardíaca aneurisma cardiac surgery aneurism |
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Español | |
Sociedad de Cirugía del Uruguay | |
Revista Cirugía del Uruguay | |
https://revista.scu.org.uy/index.php/cir_urug/article/view/2198 | |
Acceso abierto |
Sumario: | The experience obtainel through 10 aneurisms of ruptured abdominal aorta which were operated upon, is reviewed. Operatory death rate is as high as 50 % , which is in agreement with the majority of world statistics so far presented. From the clinical point of view the shock factor is the most important with respect to prognosis. Two different groups of patients with this disease are presented to the surgeon: the first is formed by those arriving to the operation in stabilized cardio-circulatory conditions, having had a generally intense but temporaryshock a few hours or days before surgery; the other group is formed by those patients with a picture of severe and persistent shock who have to be operated upon in this condition. Survivals consist almost exclusively of patients in the first group. Quick clamping of the supra-aneurismatic aorta, with blood replacement at that moment -and not befare-and the technique of "intra-sacular:• removal of aneurism, with its consequent saving of time and minimun disection, are factores which help to improve results in this extremely serious complication. Correct control of blood volume and adequate hydration, both in quantity and quality, are also important elements for prognosis. It is also fundamental that·the patient be watched for at least 48 hours in an intensive treatment centre. Preoperatory aligo-anuria, intra-peritoneal hemorrhage and advanced age, are ominous signs for prognosis. The paper pres. ents one extremely rare case of simultaneous rupture of the inferior vena cava and of the retroperitoneum, which was operated successfully. |
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