SURGICAL-MANAGEMENT OF 671 ABDOMINAL AORTIC-ANEURYSMS - A 13-YEAR REVIEW FROM A SINGLE-CENTER

Objective: To audit the results for abdominal aortic aneurysm (AAA) re pair from a single centre over a 13 year period. Design: Retrospective survey. Setting: Vascular unit of a major teaching hospital. Material s: Sex hundred and seventy-one consecutive patients divided into two g roups: Group A (1981-87) and group B (1988-93). Chief outcome measures : Mortality rates, cause of death and major complications in patients undergoing elective, urgent and ruptured AAAs. Results: Elective repai r was performed in 313 (47%) patients, urgent repair in 80 (12%) and e mergency repair for rupture in 278 (41%). A vascular surgeon performed the procedure in 94% of patients. The overall mortality was 21 patien ts in the elective group (6.7%), 13 in the urgent group (16%) and 148 in the ruptured group (53%). Mortality rates have not fallen during th e study period but more patients in group B had ischaemic heart diseas e. Sixty patients (9%) required further operative procedures on 66 occ asions: 24 elective cases (8%), 8 urgent cases (10%) and 28 ruptured c ases (10%). There were 23 deaths in these 60 patients (38%) who underw ent re-operation (5 elective, 2 urgent and 16 ruptured). Major postope rative complications included cardiac events in 212 (32%) patients, re spiratory failure in 202 (30%) and renal failure in 90 (13%). Major ca uses of death included cardiac disease in 67 patients (37%), cardiac d isease with coagulopathy in 22 (12%) and cardiac disease with respirat ory failure in 16 (9%). Logistic regression analysis showed that in th e elective group, cardiac or renal failure were significantly associat ed with death; and in the ruptured group cardiac, respiratory or renal failure were significantly associated with death. Conclusions: More h igh risk patients with ischaemic heart disease are undergoing AAA repa ir. Postoperative cardiac, respiratory or renal failure are significan t causes of death in AAA patients.