Emergency surgery of non-ruptured abdominal aortic aneurysm

Background and Aims: The pain of an abdominal aortic aneurysm (AAA) is beli eved to signify rupture, and emergency surgery for symptomatic AAA is a wid ely accepted practice to prevent rupture. To clarify the benefit of emergen cy surgery we evaluated the clinical course of emergency treated patients w ith non-ruptured AAAs. Material and Methods: 110 patients (90 men, mean age 69, range 49-93; 20 wo men, mean age 75, range 63-89) underwent emergency repair of non-ruptured A AA between 1970 and 1992 at the Department of Thoracic and Cardiovascular S urgery of Helsinki University Central Hospital (HUCH). Survival rates after surgery were analysed using product-limit-survivorship method. The surviva l rates after age-stratification were compared with those of patients under gone elective surgery (n=599) or emergency surgery because of ruptured AAAs (n=363) during the same period. Risk factors affecting early and late surv ival rates after operation were analysed by logistic regression analysis an d Cox proportional hazard model. Results: Thirty-day operative mortality rates were 18 % (20/110) in the eme rgency non-ruptured group, compared with 7 % (42/599) in the elective group and 49 % (179/363) in the ruptured group (p<0.05). Thirty day survival rat e was not changed among the nonruptured emergency group from 1970 to 1992, whereas the rates of ruptured and elective groups became better during the study period. Late survival rates for 30-day postoperative survivors were c learly reduced among the non-ruptured emergency group, without difference b etween the emergency operated ruptured and non-ruptured groups. Coronary ar tery disease was decreasing significantly early and late survival rates aft er emergency surgery for non-ruptured AAAs (p<0.05, logistic regression and p<0.001 Cox proportional hazard). Conclusions: Early and late mortality risk is significantly higher (p<0.001 ) after emergency surgery for haemodynamically stable non-ruptured AAA than after elective surgery, mainly because of coronary artery disease.