Repair of Abdominal Aortic Aneurysms

Abstract

The results of elective treatment of abdominal aortic aneurysms are excellent in many institutions. To our knowledge, however, no study has compared the results in a large geographic area in which patients were treated by a variety of surgeons and hospitals. We studied the results of repairing abdominal aortic aneurysms for all Medicare recipients during a single year in Kentucky. One hundred thirty-six operations were performed by 52 surgeons in 31 hospitals. Overall operative mortality was 18%; elective and emergency operative mortality rates were 6% and 49%, respectively. Advancing age did not affect outcome, but mortality due to ruptured aneurysms was higher in smaller hospitals than in larger hospitals. The low mortality for elective repair of abdominal aortic aneurysms in an elderly population by numerous surgeons in divergent hospitals is a strong indication for its liberal use compared with the high mortality and morbidity of emergency surgery.

Surgical Treatment of Ruptured Abdominal Aortic Aneurysms in the Elderly

“…[8][9][10][11] In this study, patients aged 75 years or more with ruptured AAA represented 7.9% of those who underwent surgery. Some reports suggest that emergency surgery in octogenarians is more frequent than elective AAA repair.…”

Prognostic indicators following emergency aortic aneurysm repair

“…As these patients have poor physiological reserve, morbidity is high and survival poor. Reported mortality figures following emergency repair vary between 30 and 70% [1][2][3][4][5][6], while those for elective repair are lower at 1.4-6% [1,7,8]. Furthermore, abdominal aortic aneurysms are common, with an incidence of 17-64 per 100 000 of the population in the UK [9,10], and so emergency repair of abdominal aortic aneurysm represents a significant workload for vascular surgery and critical care services.…”

The Evolution of Aortic Aneurysm Repair: Past Lessons and Future Directions

“…Evidence for type of aneurysm repair: In a nutshell 7.1 Open versus laparoscopic AAA repair Reviews of published large series of open AAA repair demonstrate consistent short-term (30-day) outcomes: death, 2-5%; myocardial infarction, 2-8%; renal failure, 2-5%; pneumonia, 5%; bleeding, 2-4%; leg ischaemia 1-4%; colon ischaemia, 1-2%; and length of stay 5 to 10 days (Lerderle et al, 2000, Johnston et al, 1998, Huber et al, 2007, Richardson et al, 1991. The short term morbidity and mortality are offset by a low rate of adverse long-term (10 or more years) outcome that include anastomotic aneurysm, 4-10%; graft infection 1-2% and thrombosis, 3% (Biancari et al, 2002;Hallet et al, 1997;Schermehorn et al, 2008 (Coggia et al, 2004).…”