Original Articles
Ruptured abdominal aortic aneurysm: A population-based study,☆☆

https://doi.org/10.1067/mva.1993.42107Get rights and content

Abstract

Purpose: The purpose of this study was to make an analysis of all ruptured abdominal aortic aneurysms in a defined population. Methods: An epidemiologic analysis of ruptured abdominal aortic aneurysms (AAAs) was made in an urban population during a 16-year period. The study was retrospective and covered a demographically defined population of 230,000 inhabitants in the city of Malmö, Sweden. Reports of all identified ruptured AAAs in Malmö from 1971 to 1986 were analyzed. The autopsy rate in the city was 85% during this period. Results: Ruptured AAAs were found in 5.6 of 100,000 persons (8.4/100,000 men and 3.0/100,000 women). No increase was found during the study period after age and sex standardization. The age-specific incidence was highest (113/100,000) in men 81 to 90 years old and (68/100,000) in women older than 90. The number of surgical interventions increased among men but not among women and the surgical mortality rate decreased from 86% to 43%. The overall mortality rate for ruptured AAA was 88%. The most common symptoms were abdominal pain and loss of consciousness. Conclusions: The validity of the study was based on a high autopsy rate. The incidence of aneurysm rupture was not low compared with other Scandinavian studies, but was low in comparison with studies from the United Kingdom. No increase in standardized rupture incidence was found. To substantially decrease the total mortality caused by rupture, operation must be performed before rupture. (J VASC SURG 1993;18:74-80.)

Section snippets

Material and methods

All patients with ruptured AAA or ruptured aneurysm of the common iliac artery who were inhabitants in the city of Malmö during the period 1971 to 1986 were registered retrospectively.

The city of Malmö in southern Sweden has a stable and well-defined urban population, ranging from 244,000 inhabitants in 1971 to 230,000 in 1986. There is only one hospital for somatic diseases in the city. The proportion of elderly people was higher than in Sweden in general22 and it increased throughout the

Results

There were 215 patients with ruptured AAA (median age 77 years, range 28 to 97) during the 16-year study period, 155 men (median age 73 years, range 28 to 94) and 60 women (median age 83 years, range 59 to 97). The age and sex distribution is illustrated graphically in Fig. 1.

. Number of ruptured AAAs by age and sex in Malmö, 1971 to 1986 (n = 215).

The annual number of ruptured AAAs increased among men (p = 0.007) during the period but not among women (p = 0.35) and the incidence per 100,000

Discussion

Although ruptured AAA would seem to be a fairly obvious cause of death, it is difficult to establish the exact number of patients who actually die of this cause, mainly because of the poor validity of official death statistics.10, 11, 12 The coding systems are often ambiguous and the death certificates are too seldom based on proper postmortem examinations. In this study the results are based on an exceptionally high frequency of postmortem examinations. Some years autopsy was done on as many

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  • Cited by (0)

    Supported by grants from the Swedish Foundation Against Heart and Chest Diseases and from the Swedish Medical Research Council (No. 00759).

    ☆☆

    Reprint requests: Henrik Bengtsson, MD, Department of Surgery, Malmö General Hospital, S-214-01 Malmö, Sweden.

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