PURPOSE: Abdominal aortic aneurysm is a complex disease that has too many clinical manifestations for classifying these patients as the ruptured and nonruptured groups. To evaluate the effect of the patients preoperative status to the surgical outcomes, the authors classified the abdominal aortic aneurysm patient's into four groups according to their preoperative status and we studied their outcomes. METHOD: Between 1992 and 2004, 117 patients underwent abdominal aortic surgery. Among the patients, 47 asymptomatic abdominal aortic aneurysm patients were classified as group I. 34 abdominal aortic aneurysm patients with abdominal pain were classified as group II. 20 ruptured abdominal aortic aneurysm patients without hemodynamic instability were classified as group III. 16 ruptured abdominal aortic aneurysm patients with hemodynamic instability were classified as group IV. We then analysed their clinical outcomes retrospectively. RESULT: Group IV received the highest number of transfusions and they showed the highest incidence of postoperative ARDS and the highest mortality rate. Group III received more transfusions and they showed a higher incidence of ARDS than Group I and II, but they had the lowest mortality rate. There were no significant differences in the transfusion amount, complication and mortality between Group I and II. CONCLUSION: Massive transfusion causes postoperative ARDS and multiorgan failure and this causes death for patients with ruptured abdominal aortic aneurysm. Preoperative hemodynamic instablity is a definite factor for massive transfusion, whitch causes ARDS and death.
Abdominal Pain ; Aortic Aneurysm, Abdominal* ; Hemodynamics ; Humans ; Incidence ; Mortality ; Postoperative Complications ; Retrospective Studies

BACKGROUND: We analyzed the long-term results of ascending aortic replacement and arch aortic replacement in acute DeBakey type I aortic dissections to measure the differences in the distal aortic changes with extension of the aortic replacement. METHODS: We reviewed 142 cases of acute DeBakey type I aortic dissections (1996–2015). Seventy percent of the cases were ascending aortic replacements, and 30% of the cases underwent total arch aortic replacement, which includes the aorta from the root to the beginning of the descending aorta with the 3 arch branches. Fourteen percent (20 cases) resulted in surgical mortality and 86% of cases that survived had a mean follow-up period of 6.6±4.6 years. Among these cases, 64% of the patients were followed up with computed tomography (CT) angiograms with the duration of the final CT check period of 4.9±2.9 years. RESULTS: There were 15 cases of reoperation in 13 patients. Of these 15 cases, 13 cases were in the ascending aortic replacement group and 2 cases were in the total arch aortic replacement group. Late mortality occurred in 13 cases; 10 cases were in the ascending aortic replacement group and 3 cases were in the total arch aortic replacement group. Eight patients died of a distal aortic problem in the ascending aortic replacement group, and 1 patient died of distal aortic rupture in the total arch aortic replacement group. The follow-up CT angiogram showed that 69.8% of the ascending aortic replacement group and 35.7% of the total arch aortic replacement group developed distal aortic dilatation (p=0.0022). CONCLUSION: The total arch aortic replacement procedure developed fewer distal remnant aortic problems from dilatation than the ascending aortic replacement procedure in acute type I aortic dissections.
Aorta* ; Aorta, Thoracic* ; Aortic Rupture ; Dilatation ; Follow-Up Studies ; Humans ; Mortality ; Recurrence ; Reoperation