Aneurisma aórtico abdominal: evolución de la morbimortalidad de la cirugía electiva durante 20 años / Abdominal aortic aneurysm: morbimortality evolution of elective surgery during 20 years

RESUMO

Abdominal aortic aneurysms (AAA) usually undergo progressive dilatation and eventually may rupture,complication that caries a high mortality rate. If certain clinical conditions, like operative risk and aortic diameter are met, all patients should be considered for surgical repair. Analysis of our results with the surgical treatment of asymptomatic AAA prompted this stydy. Our of 479 consecutive patients operated because of AAA between 1976 and 1995, 378 (79 percent) 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 favoured the use of aortic tube grafts (53 percent vs 25 percent, p < 0.01) and epidural anesthesia (95 percent vs 35 percent, p < 0.01). During the last decade only 53.3 percent of the patients received blood transfusion, compared to 95.3 percent during the first period (p < 0.001). Operative mortality decreased from 5.94 percent to 0.72 percent (p < 0.05). Postoperative hospital stay diminished from 11.2 ñ 8.2 to 9.6 ñ 6.3 days (p < 0.05). These results compare favourable with those reported from other academic centers and support our therapeutic approach. Our contemporary surgical results serve as a reference for future clinical evaluation of endovascular procedures currently under investigation