Causas de muerte en pacientes con aneurisma de aorta abdominal quirúrgico no tratado de forma electiva

Barba-Vélez, A.; Estallo-Laliena, L.; Vega de Céniga, M.; de la Fuente-Sánchez, N.; Viviens-Redondo, B.; Gómez-Vivanco, R.; Salazar-Agorria, A.; Izaguirre, M.; Bravo, E.

doi:10.1016/S0003-3170(07)75058-7

Información del artículo

Resumen

Bibliografía

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Estadísticas

Resumen

Introducción

La evolución natural de los aneurismas de aorta abdominal (AAA) grandes es su rotura si no se resecan en el momento oportuno.

Objetivo

Conocer las causas de muerte en los pacientes con un AAA quirúrgico que no han sido operados mediante reparación abierta.

Pacientes y métodos

Se estudia de forma retrospectiva a 128 pacientes con un AAA a los que no se realizó reparación abierta de forma electiva, en 38 casos (29,7%) por negativa del paciente a ser intervenido, en 64 (50%) por tener diversos factores de riesgo que aumentaban la mortalidad hospitalaria de forma significativa y en 26 (20,3%) por estar contraindicada la cirugía.

Resultados

La edad media de los pacientes fue de 78 años y 107 eran varones (83,6%) (53-96). Se llevó a cabo un seguimiento medio de 32,7 meses (rango: 0,1-146 meses). Fallecieron 107 pacientes (83,6%), de los cuales 27 (25,2%) lo hicieron por causa cardíaca y 19 (17,8%) por rotura del AAA. De los 38 pacientes que rechazaron la cirugía, fallecieron 30 (78,9%), 9 de ellos (30,0%) por rotura del AAA. De los 64 pacientes no operados por riesgo quirúrgico elevado, fallecieron 51 (79,7%), pero sólo en 6 de ellos (9,4%) la causa fue la rotura aórtica. Finalmente, todos los pacientes no operados por contraindicación fallecieron, el 15,4% por rotura del aneurisma.

Conclusiones

En este trabajo, la principal causa de muerte en los pacientes que rechazaron la cirugía electiva fue la rotura del AAA, mientras que en el resto, su fallecimiento se debió a la patología de base.

Palabras clave:

Aneurisma de aorta abdominal grande

Mortalidad y causas

No cirugía

Summary

Introduction

Large abdominal aortic aneurysms (AAA) naturally progress towards rupture if they are not excised in time.

Aim

To determine the causes of death in patients with a surgical AAA who did not undergo open repair surgery.

Patients and methods

We conducted a retrospective study of 128patients with an AAA in whom open repair was not performed electively, in 38 cases (29.7%) because the patient refused to undergo surgery, in 64 (50%) due to their having a number of risk factors that significantly increased the hospital mortality rate and in 26 (20.3%) because surgery was contraindicated.

Results

The mean age of the patients was 78 years and 107 were males (83.6%) (53-96). Mean follow-up time was 32.7 months (range: 0.1-146 months). Altogether 107 patients (83.6%) died, 27 (25.2%) of whom did so due to cardiac causes and 19 (17.8%) because of rupture of the AAA. Of the 38 patients who refused surgery, 30 (78.9%) died, 9 of them (30.0%) due to rupture of the AAA. Of the 64 patients who were not operated on because of a high surgical risk, 51 (79.7%) died but death was caused by aortic rupture in only 6 cases (9.4%). Finally, all the patients who did not undergo surgery because it was contraindicated died, in 15.4% of cases due to rupture of the aneurysm.

Conclusions

In this work the main cause of death in the patients who refused elective surgery was rupture of the AAA, whereas in the others their deaths were due to their underlying conditions.

Key words:

Large abdominal aortic aneurysm

Mortality and causes

Non-surgery

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