Treatment of abdominal aortic aneurysms in chronic hemodialysis patients.

Purpose. The aims of the study were 1. To describe the special features of the surgical treatment of abdominal aortic aneurysms in hemodialysis patien ts and of the perioperative care and 2. To study the results of this treatm ent and the long-term survival of these patients. Patients and methods. A retrospective study of the author's series was unde rtaken. Thirty-three patients were operated on for abdominal aortic aneurys ms. The 30 male and three female patients ranged in age form 39 to 78 years (mean: 55.3). Eighty percent of the patients were operated on during the f irst five years following the beginning of maintenance hemodialysis. Preope rative assessment of patients' condition was usual. All patients were opera ted on from six to 18 hours after a dialysis. The surgical repairs consiste d of short prostheses, whenever possible, so as not to make subsequent rena l transplantation more difficult. Hemodialysis was resumed on the day of su rgery in a few patients or later, according to the level of kaliemia. Results. Postoperative mortality was 9 % and morbidity 18 %. Secondary or l ate vascular operations were required in 10 patients (30 %). Only eight pat ients (24 %) underwent secondary renal transplantation. The long-term survi val rate was 43 % at five years and 11 % at ten years. Late deaths were due to coronary artery disease or to worsening of arterial lesions in the lowe r limbs. Conclusions. The vascular risks are increased in dialysis patients and thei r arterial lesions are especially severe. The surgical treatment is not dif ferent from that performed in non dialysed patients. Mortality and morbidit y are acceptable. The long-term prognosis is poor.