Abstract
There is likely no clinical scenario with more demanding decision making for the vascular surgeon than a ruptured abdominal aortic aneurysm (RAAA). Any hope of survival depends upon immediate evaluation, counseling of the patient and family, and repair. However, the early mortality after RAAA remains high at 30–50 % in many contemporary reports, and a subset of patients have been found to have an exceedingly small probability of surviving repair. In order to aid the vascular surgeon in counseling patients and avoiding futile repair, multiple analyses have been conducted to identify factors predictive of in-hospital or 30-day mortality, including factors predictive of “certain death.” This chapter will review existing models for predicting early mortality after RAAA repair and attempt to distill from the existing literature those preoperative, intraoperative, and postoperative factors which have been consistently identified as the harbingers of an extremely high or “certain” mortality. This chapter will also briefly review the role of endovascular repair for RAAA and its impact on survival after RAAA repair.
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