Outcome of acute renal failure following surgical repair of ruptured abdominal aortic aneurysms

Objectives: to establish the mortality of ARF following surgical repair of ruptured abdominal aortic aneurysms (AAAs) and to identify clinical variables which might assist in predicting outcome. Design, materials and methods: all cases of ARF complicating repair of ruptured AAAs treated at Leicester General Hospital between 1984 and 1996 were identified in a retrospective stud based on review of clinical records. The main outcome measured were overall mortality, duration of hospital treatment and renal function in survivors. Results: in 65 cases identified, overall hospital mortality was 75%. Six patients did not receive RRT, since their clinical state was judged irreversible all died. Of the 16 survivors, 11 were left with irreversible renal impairment and one patient required maintenance dialysis. Over half of the survivors had died at 5 years' follow-up. Non-survivors had more vascular disease (p = 0.048), required more surgery during AAA repair (p = 0.042) and were more likely to have developed multiple organ failure (p = 0.01). A clinical severity score based on these three variables allowed stratification into prognostic groups. Conclusions: ARF following surgical repair of ruptured AAA has an overall hospital mortality of 75%. A clinical severity score, calculated at the time dialysis was considered, may assist in prediction of outcome.