25-YEAR TRENDS IN RESECTION OF ABDOMINAL AORTIC-ANEURYSMS

An attempt was made to document trends that have occured over a 25-yea r period in clinical presentation, preoperative evaluation, operative management, and patient outcome in patients with an abdominal aortic a neurysm. The experience (574 aneurysmectomies) of one cardiovascular s urgical group was analyzed by retrospective review of hospital and off ice records. Changes over time of patients' ages, aneurysm sizes and s tatuses, prior myocardial revascularization, operative mortality, and certain other parameters were evaluated. During the period of study, t here was a significant decrease in aneurysm size, increase in patients ' ages, and an increased incidence of previous coronary artery bypass. No ruptured aneurysm was < 5 cm in diameter. The incidence of rupture and the operative mortality in patients with a ruptured aneurysm did not change significantly. There was a significantly (p = 0.03) lower o perative mortality of 0.4% in the latter half of the series for electi ve aneurysmectomy. Increased utilization of preoperative cardiologic e valuation, and myocardial revascularization, has been associated with a decreased operative mortality in patients undergoing elective aneury smectomy even though the patients are now older and have more age-rela ted comorbidities. Elective aneurysmectomy should be offered to most p atients when an abdominal aortic aneurysm is greater than or equal to 5 cm in diameter.