Comparison of Ruptured Thoracoabdominal and Abdominal Aortic Aneurysms

Rupture of thoracoabdominal aortic aneurysm (TAAA) or abdominal aortic aneurysm (AAA) is a vascular emergency associated with high rates of morbidity and mortality. Rupture of AAA has been extensively studied, but the outcome of ruptured TAAA is less clearly defined.We retrospectively compared outcomes of ruptured TAAAs and AAAs seen at Baylor University Medical Center. Twenty-one patients presented with TAAA rupture from 1985 to 1995:15 of them underwent emergent repair, 10 of whom died (67% mortality). Of the other 6 patients, 3 did not have surgery because of their moribund conditions or prohibitive comorbidities on presentation, 1 patient was transferred elsewhere for treatment, and 2 patients died before surgery. In comparison, from 1990 to 1995, 31 patients presented with ruptured AAA; all received immediate operative repair, and 14 of them died (45% mortality). Multiple postoperative morbidities occurred in all 5 TAAA survivors (100%), including renal failure in 4 patients (80%). In comparison, the 17 ruptured AAA survivors had a 59% (10) morbidity rate; 23% (4) had renal insufficiency. Paraplegia occurred in 1 of the 5 TAAA survivors and in none of the AAA survivors.The morbidity and mortality rates for patients who have TAAA or AAA rupture remain high despite advances in operative and postoperative care. Comparison of the TAAA and AAA cohorts reveals a higher morbidity rate in the TAAA group-specifically, an increased incidence of paraplegia and renal failure.