Long-term outcome of patients who underwent open abdominal aortic aneurysm repair

Abstract

INTRODUCTION: The aim of the study was to evaluate the short and long-term outcomes in patients who underwent open infrarenal abdominal aortic aneurysm repair. METHODS: Consecutive patients with open repair of infrarenal aortic aneurysm at our institution from 1 July 1990 till 30 June 2012 were reviewed from a prospective collected departmental database. Short-term outcomes included 30 days mortality and peri-operative complications. Long-term survival and secondary intervention were also reported. RESULTS: 383 patients (317 males, Median age 72 with range 15–90) underwent open infrarenal aortic aneurysm repair during the period, of whom 266 (69.5%) were elective, 18 (4.7%) were urgent for symptomatic but non-ruptured cases, and 99 (25.8%) were emergency procedures for ruptured aneurysms. Mean aneurysm size was 6.5 cm (range 2.5–15.0). All patients were followed up for at least 24 months with mean follow up period 163 months. Overall 30 days mortality was 11.0% (36.4% for ruptured; 11.1% for symptomatic, 1.5% for elective, p <0.001). Systemic complications included 50 cardiac events, 52 respiratory events, 6 renal events, 3 cerebral vascular accidents and 1 deep vein thrombosis/ pulmonary embolisms. Local complications included 1 anastomotic/graft hemorrhage, 10 distal thrombosis/embolism, 5 bowel ischemia, 1 spinal cord ischemia, 17 wound complications. The ruptured group presented survival of 53.5%, 50.5%, 47.5%, 42.3%, 38.0%, 23.7% at 12, 24, 36, 48, 60 and 120 months respectively; while non-ruptured ones were 91.5%, 88.0%, 83.7%, 78.3%, 73.0%, 43.0% (Log rank p <0.001). For those who died after 30 days of operation, only 4 patients died of aneurysm related mortality. A total of 3 (0.8%) patients underwent secondary interventions were recorded: 1 for late aorto-enteric fistulae and 2 for anastomotic pseudoaneurysms. CONCLUSION: In the current era of endovascular repair, open infrarenal aneurysm repair is safe and effective, and has low secondary interventions rates.