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Objective: The objective of this study was to examine patterns of referral, management, and outcome of patients with ruptured abdominal aortic aneurysm (RAAA) within the catchment area of this regional vascular unit (RVU). Methods: Referral, management, and outcome data regarding 972 consecutive patients admitted to the hospital or certified deceased in the community because of RAAA between January 1, 1989, and December 31, 1995, were retrieved from prospectively gathered computerized national and local databases. Results: Of 381 (39.2%) patients admitted to this unit, 316 (82.9%) underwent surgery, and of those, 188 (59.5%) survived. There was no significant difference in overall mortality between patients who were admitted directly to this unit (152 of 310, 49%) and those who were transferred from elsewhere (41 of 71, 58%). Surgical patients traveled significantly farther to the RVU than nonsurgical patients (P < .001), but there was no significant difference in traveling distance between surgical patients who survived and those who did not. Of 372 (38%) patients who were admitted to other units and not transferred, 24 (6.4%) underwent surgery and 14 (3.8%) survived. Of 972 patients, the overall community mortality from RAAA was 770 (79%). Conclusion: Transferring patients from outlying units did not appear to prejudice operative outcome in this RVU. However, less than half of all RAAA patients were transferred, and only a small minority of those not transferred underwent surgery. Although the overall community mortality from RAAA was similar to that reported in earlier studies from other regions and countries where centralization has not occurred, centralization of vascular surgical services may be associated with an inappropriately low operation and survival rate for those patients who are not transferred to the regional center. The effect of centralization on the community outcome of emergent vascular surgical conditions requires further investigation. (J Vasc Surg 1999;30:922-8.)

Objective To retrospectively assess the outcome of endovascular stent-graft implantation for thoracic aortic transections (ETAT). Design Retrospective review. Methods 16 patients median age 30 years, treated between May 2000 and April 2007. Median injury severity score was 33 (range 29 to 66) in 14 acute patients; 2 patients had thoracic pseudoaneurysms. The Cook-Zenith endograft was used in eight patients, Medtronic-Talent (6) and Gore-Excluder (2). Average procedure time was 90 minutes, blood loss 100 (range 40 to 3000) mls, screening time 10.8 (range 5.9 to 22.6) minutes, and contrast dose was 195 (range 60 to 400) mls. Results Graft deployment was successful in all cases. There was one death within 30 days. The left subclavian artery was completely covered in one case, and partially in three. Two patients had Type I endoleak, and one delayed Type II endoleak. One patient had iatrogenic right coronary artery dissection. Two patients developed difficult to treat hypertension, and one acute renal failure. Conclusion Endovascular intervention is a safe and effective treatment for aortic transection in multiple trauma patients. ETAT reduces the major morbidity and mortality associated with open repair in multiple trauma patients. The majority of these patients are young and long-term follow up is necessary to assess graft durability.