Clinical case of successful treatment of a patient with distal aortic aneurysm rupture and massive blood loss

O.M. Klygunenko, Yu.O. Ploshchenko, S.P. Novikov, O.V. Vasylyshyn, Yu.B. Baida, L.V. Borodai, I.K. Borodina


The article presents a clinical case of successful treatment of massive blood loss, which 2 times exceeded the fatal hemorrhage, in surgical intervention for distal abdominal aortic aneurysm rupture. In recent years, in case of massive bleeding, the Damage control resuscitation strategy has become widespread. It consist in the rapid arrest of bleeding surgically, before this — in adherence to the restrictive strategy of volume replacement in order to achieve the target pressure, with systolic one of 80–90 mmHg, which provides a minimum safe level of tissue perfusion, early application of the protocol of massive transfusion with the erythrocytes — plasma — platelets — cryoprecipitate ratio of 1 : 1 : 1 : 1 in effective therapeutic doses (fresh frozen plasma 20 ml/kg, packed red blood cells 15–20 ml/kg), early prophylaxis of coagulopathy with the use of inhibitors of fibrinolysis. The article presents the volume and composition of infusion and transfusion therapy, its effect on hemodynamics, diuresis, water balance and laboratory data. Due to the integrated actions of anesthesiologists of the department, adherence to the Damage control resuscitation, the treatment of the patient was successful.


aneurysm; massive blood loss; infusion and transfusion therapy


European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms.

Mani K., Venermo M., Beiles B., Menyhei G., Altreuther M., Loftus I. et al. Regional differences in case mix and perioperative outcome after elective abdominal aortic aneurysm repair in the vascunet database // Eur. J. Vasc. Endovasc. Surg. — 2015 Jun. — 49. — Р. 646-52.

Desgranges, ECAR Investigators. ECAR (Endovasculaire ou Chirurgie dans les Anévrysmes aorto-iliaques Rompus): a French randomized controlled trial of endovascular versus open surgical repair of ruptured aorto-iliac aneurysms // Eur. J. Vasc. Endovasc. Surg. — 2015. — 50. — 303e10.

IMPROVE trial investigators, Powell J.T., Sweeting M.J., Thompson M.M., Ashleigh R., Bell R. et al. Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomized trial // BMJ. — 2014. — 348. — 7661.

Reimerink J.J., Hoornweg L.L., Vahl A.C., Wisselink W., van den Broek T.A., Legemate D.A. et al. Amsterdam Acute Aneurysm Trial Collaborators. Endovascular repair versus open repair of ruptured abdominal aortic aneurysms: a multicenter randomi­zed controlled trial // Ann. Surg. — 2013a. — 258. — 248e56.

Markovic M., Tomic I., Ilic N., Dragas M., Koncar I., Bukumiric Z. et al. The rationale for continuing open repair of ruptured abdominal aortic aneurysm // Ann. Vasc. Surg. — 2016. — 36. — 64e73.

Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology. — First update 2016. — Р. 332-395.

Клигуненко Е.Н., Сединкин В.А. Об эффективности рестриктивного типа восполнения острой акушерской кровопотери: Збірник наукових праць співробітників НМАПО ім. П.Л. Шупика. — К., 2015. — Вип. 26 (к. 6, ч. 2). — С. 132-136.

Клигуненко Е.Н., Кравец О.В. Интенсивная терапия кровопотери: Учебно-методическое пособие. — Днепропетровск: Пороги, 2005. — 2-е изд-е, доп. — 150 с.

Сединкин В.А., Клигуненко Е.Н. Обзор рекомендаций по интенсивной терапии острой массивной кровопотери в акушерстве // Медицина неотложных состояний. — 2017.

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