Open surgery in endovascular aneurysm repair era: simplified classification in two risk groups owing to factors affecting mortality in 137 ruptured abdominal aortic aneurysms (RAAAs).

Our objective is to identify in 137 true RAAAs operated consecutively in open surgery: (1) diagnostic therapeutic aspects capable of influencing results, (2) risk classes with different prognosis, (3) any situations where the prognosis is so negative that surgery is not recommended. The relationship of 16 anamnestic, clinical and technical parameters prospectively collected with 30-day mortality was retrospectively evaluated by uni- and multivariate analyses. Thirty-day mortality was 37%. The univariate analysis identified as mortality predictors Hb ≤ 8 g/dl and circulatory shock at hospitalisation, but following the multivariate analysis only circulatory shock was a certainly significant risk-factor. The cumulative effect on mortality of the two parameters identified at univariate analysis translates into a statistically significant difference in mortality between two groups of patients: A (no or just one risk-factor) and B (two risk-factors). To reinstate euvolemia, rather than adequate haemoglobin values, improves the chances of success. A simple prognostic index into two risk classes is feasible, but abstention from surgery is not justified in any type of patient.

Risk factors for immediate results and long-term survival following elective open surgery for AAA. Statistical analysis of 1111 consecutively-treated patients.

AIM OF THE STUDY: Perioperative and 10 years follow-up risk factors for 1111 consecutive open AAA repairs were statistically analyzed (X2-test and Log-rank test methods for univariate analysis, and logistic regression model and Cox proportional-hazard model for multivariate analysis). Overall operative mortality rate was 2.7%, and significant risk factors were: 1) univariate analysis: Age (>70 years 3.9% vs 1.5% <70 years); CAD (4.3% vs 1.9% without CAD); PAD (4.7% vs 2.0%); III-IV ASA classes (3.8% vs 0% in I-II ASA classes); 2) multivariate analysis: only ASA classes. RESULTS: Long-term survival (42.3 +/- 32.6 months) was 93% and 88% at 3 and 5 years respectively, with 0.2% graft-related deaths, and significant risk factors were 1) univariate analysis: Age (92% and 84% at 3 and 5 years in patients aged >70 vs 94% and 91% <70 years); ASA classes (91% and 87% at 3 and 5 years in ASA III-IV vs 98% and 92% in ASA I-II); CAD (92% and dell'85% vs 94% and 90% without CAD); COPD (90% and 80% vs 95% and 92% without COPD); CRF (90% and 82%, vs 94% and 89% without CRF); suprarenal aortic cross-clamping for pararenal aneurysms (91% and 77% in pararenal AAA, vs 94 % and 90% in infrarenal AAA; 2) multivariate analysis: Age; ASA classes; pararenal aneurysms. There was a close relation between number (0-5) of risk factors in each patient and early and late complications. These data are very satisfactory overall, and even in high risk patients who are routinely considered for EVAR.