Who can survive a ruptured rAAA?

Society for Vascular Surgery journal publishes quick, new test to assess the odds

CHICAGO, Illinois, Oct. 18, 2018 – A ruptured abdominal aortic aneurysm (rAAA) is a medical emergency.

It is enormously stressful for the patient and family because life and death decisions must be made within minutes. Fortunately, a fast, new tool to determine a patient’s chances for survival – before surgery – may help physicians make life-saving decisions.

The Society for Vascular Surgery reports that, based on a study of 330 rAAA patients at Harborview Medical Center (Seattle, Wash.), the risk-scoring measurement offers a quick way to evaluate emergency room patients on the likelihood that they can survive rAAA surgery. The risk score was recently published in the Journal of Vascular Surgery and was developed by Dr. Niten Singh, a professor of surgery, and his colleagues in the division of vascular surgery at University of Washington.

“What you don’t want to do is transfer a patient with a 100 percent likelihood of dying to a specialist and have the family drive a long way, only to have the patient expire while being transported,” Dr. Singh said. “The family could have spent those last hours together instead of on the road.”

The abdominal aorta is a large artery that serves the entire lower half of the body. If the artery has an aneurysm that ruptures, death can follow within a short time. But despite the danger, some patients can be saved with surgery.

Ruptured AAA surgery is a vascular specialty usually handled at larger hospitals that have vascular surgeons on staff. Typically, a rural hospital may have no vascular surgeon available for that type of urgent surgery, Dr. Singh said. In such cases, the ER physician will call a vascular surgeon to discuss what to do. What follows is a fast, but life-altering conversation about how likely it is that the patient can survive transport and surgery. Most patents are elderly and have other health issues that can impact their survival.

The Harborview rAAA scoring system helps surgeons, ER physicians and family to understand the likelihood of survival up to 30 days. It measures patients based on four factors. Patients earn one point for each risk factor, and those with a score of four are considered unlikely to survive surgery. The simple score is based on factors that are very quick and easy to determine while in the emergency room. The score also offers a good way to explain the surgeon’s recommendation to the family, Dr. Singh said.

“It’s a shock for the family,” he said. “They might have been eating dinner and all the sudden they are in the emergency room and someone might be about to die. If the family really wants everything done, and if the patients can survive transport, we will try to get them through the procedure. However, the patient may not ever go home and might have a rocky hospital course ahead.”

Knowing those odds may help a family understand that it is not advisable to put their loved one through the trauma and pain of a surgery that won’t ultimately extend life, he noted.

The four risk factors are:

  • Over 76 years old
  • pH less than 7.2 (pH refers to acid/base balance. When there is bleeding, the body produces more lactic acid and the pH is lower than the normal pH 7.4)
  • creatinine concentration in the blood higher than 2.0 mg/dL. (This is an indicator of kidney function; the higher the number, the worse the kidney function)
  • systolic blood pressure has at any time been over 70 mm Hg

The JVS article is open source through Nov. 30, 2018 at vsweb.org/JVS-RiskScore.

This information is not intended, and should not be relied upon, as a substitute for medical advice or treatment. It is very important that individuals with specific medical problems or questions consult with their doctor or other health care professional.