Difficult. Ruptured aa is very dangerous with high mortality. There is also risk of disability like kidney failure, stroke and paralysis. To get a patient with ruptured aa out of the or to the ICU is regarded as a "save" for the anesthesiologist.
Yes. Odds are against him, even if he is standing in the hospital at the time the AAA ruptures. We do, however, save 10-30% of ruptured AAA with surgery, either open surgery or endovascular stent grafting. Odds are better if the person is less than 70 yrs old, is not in shock, and does not have heart or kidney disease.
Yes, and. ..... ...We have gotten much better. Better ems services, better preoperative management, and the widespread use of endografts have made survival of ruptured AAA better...But it is still much much worse than if we fix them electively.
Yes!!! Super emergent. Very risky. At our hospital we place an endograft for this.