Management of ruptured abdominal aortic aneurysm

Ruptured abdominal aortic aneurysm (rAAA) is defined as either free hemoperitoneum or retroperitoneal hematoma or presence of blood outside the aortic wall on computed tomographic scan. Symptomatic AAA usually has a much better prognosis than that of rAAA. Despite improvements in medical field the mortality from rAAA has only marginally improved. The preoperative, operative and postoperative management of ruptured abdominal aortic aneurysm continues to evolve and as one question or controversy is settled another one frequently presents itself and in some instances re-presents itself with the advent of endovascular interventions. The current management continues to be dynamic and continues to evolve. The preoperative strategies including obtaining computed tomographic scan in hemodynamically stable patients, transfer to center with high volume and surgeon's with high volume, preoperative permissive hypotension; the selection of treatment modality (open versus endovaseular repair) and perils about each approach; and the postoperative strategies are discussed in the paper. We conclude that implementation of a standardized protocol and regionalization to centers or excellence is paramount importance to improve outcomes. Currently, there is no evidence for preferential application of endovascular techniques in the treatment of ruptured abdominal aortic aneurysm.