A 21-YEAR EXPERIENCE OF ABDOMINAL AORTIC-ANEURYSM OPERATIONS IN EDINBURGH

Background This study reviews the results of infrarenal abdominal aort ic aneurysm (AAA) surgery over 21 years (1 January 1976 to 31 December 1996). Methods A prospectively gathered database was analysed. Result s Infrarenal AAA repair was performed in 1515 patients: 492 (32.5 per cent) had elective repair of an asymptomatic AAA; 194 (12.8 per cent) had elective repair of a symptomatic AAA; 156 (10.3 per cent) had emer gency repair of a symptomatic non-ruptured AAA; and 673 (44.4 per cent ) had surgery for a ruptured AAA. The 30-day and/or same admission mor tality rates were 6.1, 5.8, 14.1 and 37 per cent respectively. Operati ve mortality increased in all four groups over the study interval, alt hough this only attained statistical significance in patients having e lective repair of a symptomatic, non-ruptured AAA. There was a signifi cant increase in the age of patients undergoing elective repair of an asymptomatic AAA, but not in the other three groups. There was also a significant increase in the proportion of straight 'tube' grafts inser ted in all four groups. Conclusions It remains the minority of patient s who have elective operation before the onset of symptoms and/or rupt ure. Despite anaesthetic and surgical specialization, the results of A AA repair have not improved over the past two decades. Operative morta lity may be increasing, possibly because of the increasing age and ass ociated comorbidity of the patients presenting to this unit.