Management of Emergency Aortic Aneurysmectomy

Graft reconstruction for abdominal aortic aneurysm was proposed by Dubost et al. [1] in 1952. The mortality rate within 30 days of surgery has decreased from 15% mean in the 50s and 60s to 1–6% in the 80s. New insights in surgical techniques and pathogenesis of aortic aneurysm formation, improvement of preoperative screening tests for perioperative myocardial ischemia and infarction, more sophisticated intraoperative approaches to assess hemodynamic function and myocardial ischemic episodes can be the factors responsible for mortality declining. In contrast, in patients with ruptured aortic abdominal aneurysms, depending on the severity of hemodynamic instability at the time of the surgery, 30 day death rates may yet reach 70% nowadays [2]. In elective abdominal aortic reconstruction the stress imposed upon the patient by aortic cross clamping and unclamping always represents difficult problems to be managed by the anesthesiologist. It is important to consider that a high percentage of these patients also present a host of coexisting diseases, being of paramount importance ischemic heart disease. However, in emergency situations such as surgical treatment of ruptured aortic aneurysms, these problems usually seen in an elective surgical situation, become more complex, representing one of the most challenging situations to both the surgeon and the anesthesiologist. Despite all modern technical support, mortality rates in this condition are still at the level of 50% in most centers in the world [3, 4].