LONG-TERM SURVIVAL AND LATE COMPLICATIONS AFTER REPAIR OF RUPTURED ABDOMINAL AORTIC-ANEURYSMS

Purpose: Long-term survival and late vascular complications in patient s who survived repair of ruptured abdominal aortic aneurysms (RAAA) is not well known. The current study compared late outcome after repair of RAAA with those observed in patients who survived elective repair o f abdominal aortic aneurysms (AAA). Methods: The records of 116 patien ts, 102 men and 14 women (mean age: 72.5 (8.3 years), who survived rep air of RAAA (group I) between 1980 to 1989 were reviewed. Late vascula r complications and survival were compared with an equal number of sur vivors of elective AAA repair matched for sex, age, surgeon, and date of operation (group II). Survival was also compared with the age and s ex-matched white population of west-north central United States. Resul ts: Late vascular complications occurred in 17% (20/116) of patients i n group I and in 8% (9/116) in group II. Paraanastomotic aneurysms occ urred more frequently in group I than in group II (17 vs. 8, p = 0.004 ). At follow-up, 32 patients (28%) were alive in group I (median survi val: 9.4 years) and 53 patients (46%) were alive in group II (median s urvival: 8.7 years). Cumulative survival rates after successful RAAA r epair at 1, 5, and 10 years were 86%, 64%, and 33%, respectively. Thes e were significantly lower than survival rates at the same intervals a fter elective repair (97%, 74%, and 43%, respectively, p = 0.02) or su rvival of the general population (95%, 75%, and 52%, respectively, p < 0.001). Coronary artery disease was the most frequent cause of late d eath in both groups. Vascular and graft-related complications caused d eath in 3% (3/116) in group I and 1% (1/116) in group II. Cox proporti onal hazards modeling identified age (p = 0.0001), cerebrovascular dis ease (p = 0.009), and number of days on mechanical ventilation (p = 0. 01) to be independent prognostic determinants of late survival in grou p I. Conclusions: Late vascular complications after repair of RAAA wer e higher and late survival rates lower than after elective repair. The se data support elective repair of AAA. As two-thirds of the patients discharged after repair of RAAA are alive at 5 years, aggressive manag ement of RAAA remains justified.