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[Improved treatment of abdominal aortic aneurysms. Progress over 17 years]
T Dukefoss1, T Haukeland, J Vaage
1Kirurgisk avdeling, Regionsykehuset i Tromsø.
Insights
Surgical outcomes for abdominal aortic aneurysms (AAA) improved significantly between 1970-1986. Elective AAA repair became safer, with no deaths in the last three years, though ruptured aneurysms remain high-risk.
Area of Science:
- Vascular Surgery
- Aortic Aneurysm Research
- Surgical Outcomes Analysis
Context:
- Analysis of abdominal aortic aneurysm (AAA) cases at the University Hospital in Tromsø from 1970-1986.
- Observational study tracking patient demographics, aneurysm status (elective, impending rupture, ruptured), and operative mortality.
- Documented increase in annual AAA admissions from 4.5 (1970-76) to over 20 (1984-86).
Purpose:
- To evaluate the trends in abdominal aortic aneurysm (AAA) treatment and associated mortality over a 17-year period.
- To assess the safety and efficacy of surgical interventions for AAAs, stratified by clinical presentation and patient age.
- To identify improvements in operative and early postoperative mortality rates.
Summary:
- A total of 179 patients (155 men, 24 women) underwent AAA surgery. Elective operations had a 7% mortality (5/76), impending rupture 29% (14/49), and ruptured aneurysms 61% (33/54).
- Significant reduction in operative and early postoperative mortality observed over the study period.
- No deaths occurred in elective AAA operations during the final three years (1984-86).
- Mortality for impending rupture was 8%, and for ruptured aneurysms was 45% in the later period.
- Safe surgical outcomes for elective AAAs were demonstrated even in patients over 80.
- High operative mortality persists for ruptured aneurysms in patients over 70.
Impact:
- Demonstrates the increasing incidence of abdominal aortic aneurysms (AAAs).
- Highlights significant improvements in surgical outcomes and reduced mortality for elective AAA repair.
- Provides evidence for the safety of elective AAA surgery in elderly patients.
- Underscores the continued high risk associated with ruptured abdominal aortic aneurysms, particularly in older populations.
Abstract:
During the period 1970-86, 155 men and 24 women were operated on for abdominal aortic aneurysms at the University Hospital in Tromsø. Elective operations were performed in 76 patients with an operative mortality of 5 (7%), impending rupture in 49, of whom 14 died (29%) and ruptured aneurysms in 54 patients, of whom 33 (61%) died. There has been a substantial increase in the number of patients per year admitted with abdominal aneurysms, from an average of 4.5 during the years 1970-76 inclusive, to over 20 during the years 1984-86. Operative and early postoperative mortality have been reduced and there has been no death following elective operations during the last three years of the reported period. Mortality was 8% for impending rupture and 45% for ruptured aneurysms. Electively abdominal aortic aneurysms can be operated safely even in patients over the age of 80. Ruptured aneurysms, however, still carry a high operative mortality in patients over the age of 70.