EMERGENCY SURGERY FOR RUPTURED ABDOMINAL AORTIC ANEURYSMS: A REVIEW OF TECHNIQUES AND PROTOCOLS

Abstract

Abdominal aortic aneurysm (AAA) is a localized and progressive dilation of the abdominal aortic wall, representing a potentially fatal condition if it ruptures. AAA rupture is a medical emergency that requires immediate surgical intervention to avoid significant mortality. Effective management of this emergency depends on the application of advanced surgical techniques and specific protocols to maximize patient survival. This review aims to examine current emergency surgical techniques for ruptured abdominal aortic aneurysms, evaluate pre- and post-operative management protocols, and discuss recent innovations that have the potential to further improve patient outcomes. By analyzing clinical studies, practice guidelines and the experiences of reference centers, we aim to provide a comprehensive and up-to-date overview of best practices in the emergency treatment of AAA rupture. This literature review aims to compare the efficacy and safety of endovascular and open repairs for abdominal aortic aneurysms (AAA), focusing on studies that address aspects such as quality of life, prevalence and clinical guidelines. The databases used include BMJ Open, New England Journal of Medicine, Journal of Vascular Surgery, São Paulo Medical Journal and J Vasc Bras, with a time frame from 2004 to 2019. AAA rupture is a surgical emergency that requires a rapid and effective response. Early diagnosis plays a crucial role, usually carried out using imaging tests such as computed tomography (CT) or ultrasound. Once the rupture is confirmed, the main objective is to stabilize the patient hemodynamically and prepare them for immediate surgical intervention. There are two main surgical approaches to the treatment of AAA rupture: open repair and endovascular repair. Open repair involves laparotomy, proximal and distal control of the vessel, and replacement of the aneurysmal segment with a synthetic graft. This technique has traditionally been considered standard of care, offering direct control over the rupture site and long-term durability. On the other hand, endovascular repair is a minimally invasive approach that uses image-guided catheters to implant an endoprosthesis inside the aneurysm, excluding it from the bloodstream. This technique offers significant advantages in selected patients, such as shorter recovery time and lower perioperative morbidity, although it can present technical challenges in cases of acute rupture. Perioperative strategies are essential to reduce complications and improve results. This includes optimizing tissue perfusion, strict blood pressure control, coagulation management and intensive post-operative monitoring. Specific guidelines, such as those provided by the Society for Vascular Surgery (SVS) and the European Society for Vascular Surgery (ESVS), help to standardize care and improve clinical outcomes. In conclusion, emergency surgery for ruptured abdominal aortic aneurysms is a critical intervention that requires a rapid and multidisciplinary approach. The choice between open and endovascular repair depends on the patient’s hemodynamic stability, the anatomy of the aneurysm and the expertise of the surgical team. The implementation of advanced techniques and compliance with strict protocols are key to maximizing survival and reducing the morbidity associated with this devastating condition. Continued advances in research and clinical practice are essential to further improve the long-term outcomes of patients with ruptured AAAs.