ABDOMINAL ANEURYSMECTOMY AND DETERMINANTS OF IMPROVED RESULTS AND LATE SURVIVAL - SURGICAL CONSIDERATIONS IN 672 OPERATIONS AND 1-15 YEAR FOLLOW-UP

The present communication is concerned with 672 abdominal aneurysmecto mies performed over a period of 24 years. All aneurysms with diameter 4 cm and above, were considered for surgery. Emphasis is given on fact ors determining post operative results and late survival.There was an age ranging from 38 to 92 years (mean 68.3). Elective surgery was perf ormed in 434 cases with mortality 2.8%. In 100 symptomatic patients mo rtality was 4%. In 115 cases emergency undertaking was necessary. From this particular group, 80 cases represent formal rupture with mortali ty 41%. In the remaining 35 patients with symptomatology compatible wi th ''impending rupture'' mortality was 6%. There were 5 cases with inf lammatory aneurysm with no incidence of death and 18 with simultaneous renal reconstruction. Mortality in the latter group was 11%. Risk fac tors including heart disease, hypertension and other associated pathol ogy, were responsible for the majority of early deaths within the peri od of 30 post operative days and late mortality. Concerning late death s, cardiac cases were predominant (24%), followed by cerebrovascular i nsufficiency (8%), cancer (5%) and chronic pulmonary disease (6%). In the overall follow-up, parameters such as hypertension with and/or wit hout associated heart disease, symptomalology due to aneurysm and othe r associated pathology, were comparatively used in selective group of patients. Late mortality was investigated among three group of patient s and classified according to the 60, 70 and 80 decade of life. An ent ry form listing pertinent data was constructed and completed on the ba se of direct information from 489 (72.7%) and indirect from 183 (27.3% ) patients. Investigation of late mortality through the Bureau of vita l statistics, permitted construction of life tables and statistically descriptive analysis presented in tubular and graphic form.