Despite refinements in elective resection of abdominal aortic aneurysms, morbidity and mortality rates for ruptured abdominal aortic aneurysms (RAAAs) remain high. Between January 1, 1980 and December 31, 1989, we treated 208 patients with RAAAs whose mean age was 70 years. The overall mortality rate was 49.5%. Logistic regression analysis showed that three factors correlated with predicted patient survival. Patients < 70 years old had a survival rate of 65.7% compared with a survival rate of 37.4% in patients > 70 years old (p < 0.001). Among "stable" patients (preoperative blood pressure consistently > 90 mm Hg), 88.9% survived compared with 40.9% of "unstable" patients (blood pressure < 90 mm Hg) (p < 0.001). Of the patients with free intraperitoneal rupture, 38.3% survived compared with a survival rate of 79.6% of patients with rupture confined to the retroperitoneum (p < 0.001). Despite a high overall mortality rate in patients with RAAAs, surgical intervention remains the only hope for survival. We continue to advocate an aggressive surgical approach in this group of patients.
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