Clinical Study of Abdominal Aortic Aneurysm Repair

ABSTRACT

PURPOSE: Ruptured abdominal aortic aneurysm still carries high operative mortality, but the operative mortality of elective operation for abdominal aortic aneurysm has been reduced to less than 5 percent due to an adequate management of severe influential factorstreatment of preventable coronary and carotid artery disease, intraoperative prevention of hypotension and reperfusion injury, and postoperative intensive surveilance of cardiopulmonary function. METHOD: Seventy-six AAAs patients who were treated in our vascular division between January 1996 to December 2000 were prospectively investigated in regard to clinical manifestations, operative finding, and other factors affecting the outcomes. RESULT: The male-to-female ratio was 6511 and the mean age was 63.1 years. The ruptured AAA to unruptured AAA ratio was 3046, and suprarenal to infrarenal AAA was 571. The mean maximal diameter was 6.8 (4~15) cm. The AAA associated with iliac artery aneurysm was observed in 56 patients and with occlusive arterial disease was observed 15 patients. All patients for elective surgery had a preoperative thallium myocardial perfusion scan and color duplex carotid scan, Nine of them had a coronary occlusive lesion and six of these nine patients had preoperative coronary angioplasty (3) or coronary bypass procedure (3). One of them who had carotid artery stenosis received a carotid endarterectomy after the AAA resection. The treatment were aorto-iliac bifurcation graft (80.2%), straight graft interposition of aorta (11.8%), aorto-bifemoral bypass (5.3%), and stented graft (2.6%). Two stented graft case were excluded from mortality and morbidity calculation. The postoperative complications were pulmonary complication (9.4%), renal complication (4.0%), wound infection (2.7%), small bowel obstruction (2.7%). The operative mortality of elective AAA resection was 14.5%, and elective was 2.3% (1/44). Mortality of ruptured AAA was 33.3% (10/30) in which intraperitoneal rupture (free rupture) was 85.7% (6/7) operative mortality and retroperitoneal contained rupture was 17.4% (4/23). Age was not a independent risk factor. CONCLUSION: Mortality of elective AAA resection has been reduced with careful pre-operative assessment of the patient and proper management of the risk factors. Intrapritoneal free rupture still carries unacceptably high mortality. Thus elective operation before the rupture of AAA is emphasized again.