What is the mortality rate of ruptured abdominal aortic aneurysm (rAAA) in patients who reach the hospital alive?

Explanation

## Mortality of Ruptured Abdominal Aortic Aneurysm **Key Point:** The in-hospital mortality of ruptured AAA in patients who survive to hospital is 40–70%, with an overall mortality (including prehospital deaths) approaching 80–90%. ### Mortality Stratification | Population | Mortality Rate | Notes | |------------|----------------|-------| | **Prehospital (all rAAA)** | 80–90% | Most patients die before reaching hospital | | **In-hospital (arrived alive)** | 40–70% | Depends on hemodynamic stability, comorbidities, repair method | | **After open surgical repair** | 30–50% | Highest risk in first 24–48 hours | | **After EVAR (endovascular repair)** | 20–40% | Lower perioperative mortality than open repair | | **Hemodynamically unstable at admission** | 70–80% | Very poor prognosis | | **Hemodynamically stable at admission** | 20–40% | Better outcomes with prompt intervention | ### Why Mortality Remains High Despite Modern Management 1. **Massive hemorrhage** — rapid exsanguination from a large arterial defect 2. **Ischemic complications** — spinal cord ischemia, mesenteric ischemia, limb ischemia 3. **Reperfusion injury** — after aortic cross-clamping 4. **Multiorgan failure** — secondary to shock and prolonged hypoperfusion 5. **Comorbidities** — AAA patients are typically elderly with significant cardiac and renal disease **High-Yield:** The distinction between prehospital and in-hospital mortality is critical for exam questions. Of all patients with rAAA, only 10–20% reach hospital alive; of those who do, 40–70% die despite treatment. This means only 3–6% of all rAAA patients ultimately survive. **Clinical Pearl:** Hemodynamic stability at presentation is the single strongest predictor of survival. Patients with systolic BP >90 mmHg have significantly better outcomes than those in shock. **Mnemonic — "CRASH" factors predicting poor outcome in rAAA:** - **C**ardiac comorbidity (prior MI, heart failure) - **R**enal dysfunction (Cr >1.8 mg/dL) - **A**ge >75 years - **S**hock at presentation (SBP <90 mmHg) - **H**emoglobin <8 g/dL on admission [cite:Harrison 21e Ch 297]