Elective surgery for small abdominal aortic aneurysms

Background and purpose: Surgical repair for abdominal aortic aneurysm has b ecome more frequent and the mortality associated with elective surgery has been reduced, but the overall mortality for ruptured aneurysm remains unacc eptably high. The dilemma for the Vascular surgeon is whether to operate ea rly and electively on asymptomatic small aneurysms, less than 5 cm in diame ter, or to delay surgery, adopting a wait-and-see attitude. The purpose of this retrospective study was to review a recent 5-year experience of electi ve aneurysm surgery, with special emphasis on the perioperative outcome of surgical repair of asymptomatic small aneurysms, in order to evaluate wheth er early mortality and morbidity justify an aggressive approach, Methods, T he report concerns a series of 141 consecutive patients who underwent aneur ysm repair for small (n = 63, group I) and large aneurysms (n = 76, group I I), For each group, the age, sex, risk factors and associated diseases, ope rative and aortic cross-clamping times, estimated blood loss, blood transfu sion volume, type of operation and graft, perioperative morbidity and morta lity, and causes of death were recorded and compared. Results: The majority of patients were males. The mean age of the patients was lower in group I than in group II. No statistically significant difference was found from th e comparison of the risk factors and associated diseases in groups I and II . The mean operating time was 82 minutes in group I, 98 minutes in group II , and the aortic cross-clamping time was also shorter in group I (37 min ve rsus 52 min), whereas blood loss was greater, with a statistically signific ant difference (P < 0.05), The operative mortality rate was higher in group II than in group I (1.3% versus 0%, P = NS), Conclusions: Elective small a neurysm repair is recommended in good-risk patients for the following reaso ns: (i) the operative mortality and morbidity rates are lower in small than in large aneurysm patients, and (ii) the small aneurysm repair is technica lly easier and safer to perform, In addition, there are two other considera tions that are more difficult to quantify, but may support an aggressive ap proach: the cost-benefit ratio is better with early diagnosis and elective surgery, before an emergency operation is required, and personal choice and psychological reasons can induce patients to prefer early elective repair to periodic monitoring by ultrasound or computed tomography scans. (C) 1999 The International Society for Cardiovascular Surgery. Published by Elsevie r Science Ltd. All rights reserved.