ABDOMINAL AORTIC-ANEURYSMS - A 20-YEAR CL INICAL-EXPERIENCE

Abdominal aortic aneurysms (AAA) usually undergo progressive dilatatio n and eventually may rupture, complication that carries a high mortali ty rate. If certain clinical conditions, like operative risk and aorti c diameter are met, all patients should be considered for surgical rep air. Analysis of our results with the surgical treatment of asymptomat ic AAA prompted this study. Out of 479 consecutive patients operated b ecause of AAA between 1976 and 1995, 378 (79%) were electively treated . Two decades: 1976-85 (101 patients) and 1986-95 (277 patients) were compared as far as associated medical conditions, surgical procedures, complications and mortality rate. There was no difference in age, sex , risk factors and aortic diameter. During the second decade we favour ed the use of aortic tube grafts (53% vs 25%, p<0.01) and epidural ane sthesia (94% vs 35%, p<0.01). During the last decade only 53.3% of the patients received blood transfusion, compared to 95.3% during the fir st period (p<0.001). Operative mortality decreased from 5.94% to 0.72% (p<0.05). Postoperative hospital stay diminished from 11.2 +/- 8.2 to 9.6 +/- 6.3 days (p<0.05). These results compare favourably with thos e reported from other academic centers and support our therapeutic app roach. Our contemporary surgical result serve as a reference for futur e clinical evaluation of endovascular procedures currently under inves tigation.