Results of surgical therapy and classification of non-ruptured abdominal aortic aneurysms

Introduction: Surgery for symptomatic aortic abdominal aneurysms (sAAA) is associated with an increased mortality and morbidity compared to asymptomat ic aortic aneurysms (aAAA). With the advent of endovascular therapy, an alt ernative therapeutic modality has become available. Endovascular therapy, h owever, depends on certain morphologic criteria, whereas open surgery can b e performed on any type of AAA. The purpose of this study was to analyse ou r data of surgical treatment of non ruptured AAA and to identify the amount of patients in whom endovascular therapy would have been possible. Methods: Retrospective analysis of the medical data of all patients operate d upon non ruptured AAA in our department by 3 responsible vascular surgeon s from 1995-1999. Results: 225 consecutive patients with a median age of 65 (42-95) years wer e included in the study. There were 184 (82 %) male and 41 (18 %) female pa tients with 143 (63.5 %) aAAA and 82 (36.5 %) sAAA. Patients with sAAA unde rwent emergency aneurysm repair and had a significantly increased aneurysm diameter compared to the aAAA, who underwent elective surgical aneurysm rep air (6.9 +/- 1.6 cm vs. 6 +/- 1.2 cm; p = 0.002). A total of 11 (4.9 %) pat ients had an inflammatory AAA. Smoking was found to be the only significant increased preoperative risk factor in the group of sAAA compared to aAAA ( 91 vs. 35 patients; p = 0.008). Morbidity was significantly increased in th e patients with sAAA compared to the aAAA (55 % vs. 31.5 %; p = 0.041) The mortality however did not differ significantly in the two groups (2 vs. 3 p atients; p = 0.691). Considering morphological criteria of the AAA, endovas cular therapy would have been possible in 59 (26 %) patients. However in 24 (11 %) of the 59 patients, endovascular therapy was not feasible because o f aortic kinking, heavy calcification of the aneurysm neck, a patent inferi or mesenteric artery or atherosclerotic diseased iliac arteries. Consequent ly, only 35 (15 %) patients would have qualified for an endovascular therap y. Discussion: Surgical therapy can be performed in patients with asymptomatic and symptomatic AAA with an equal low mortality. This finding underlines t he fact, that surgical therapy still remains the standard therapy for AAA. In addition, in our study only a relative small amount of patients would ha ve qualified for an endovascular therapy.