Management of Ruptured Abdominal Aortic Aneurysm

Immediate Stabilization and Diagnostic Approach

For hemodynamically stable patients with ruptured AAA and suitable anatomy, endovascular repair (EVAR) is the definitive treatment of choice over open repair, reducing 30-day mortality from 34% to 21% 1, 2
Implement permissive hypotension to decrease bleeding rate until definitive repair is achieved, with the goal of maintaining organ perfusion while minimizing ongoing blood loss 1, 2
Avoid aggressive fluid resuscitation that increases blood pressure and exacerbates hemorrhage 1, 2
If hemodynamically stable, obtain CT imaging immediately to determine if the anatomy is suitable for endovascular repair, as demonstrated by the IMPROVE trial 1, 2

EVAR reduces 30-day mortality to 21% compared to 34% with open repair in propensity-matched registry data, with a long-term survival benefit persisting between 90 days and 3 years 1, 2
Use local anesthesia rather than general anesthesia when performing EVAR to further reduce perioperative mortality 1, 2
Mortality rates with EVAR have declined to as low as 18.5% in centers using rupture protocols with an endovascular-first strategy 1, 2

Implement team-based "rupture protocols" that include early imaging for stable patients, permissive hypotension strategy, endovascular balloon occlusion under fluoroscopy to control hemorrhage, and immediate operating room availability with coordinated team response 1, 2

Overall mortality from ruptured AAA remains 80-90%, with most patients dying before reaching the hospital 1, 2