[Surgery in aneurysms of the abdominal aorta in an outlying hospital]

Abdominal aortic aneurysms have become more frequently recognized due to an improved diagnostic approach and prolonged longevity. Therefore it can be argued that aneurysmal pathology must be entirely dealt with, including its surgical therapy, in outlying non-specialized hospitals. Elective surgical treatment of aortic aneurysms is mandatory in order to acquire the technique that will provide a satisfactory efficiency and reliability in the emergency treatment of ruptured aortic aneurysms. The basic supports of aortic aneurysm surgery in outlying hospitals are the availability of postoperative intensive therapy, a competent surgeon staff and an improved diagnostic approach in order to recognize those aneurysms which are operable by the staff and those requiring very complex reconstructive procedures such as thoraco-abdominal aortic aneurysms which must be transferred to highly specialized centres. An angiography service should be set up since it represents an important support for the operation of abdominal aneurysms; however in practice it proved to be non-essential in the present case. In contrast the intensive postoperative unit must be considered vital in view of the patient's risky conditions. The experience reported here is really positive as regards expanding aneurysms given elective surgery, in which cases there was no mortality either intra- or post-operatively. The follow-up varied from 3 to 7 years. Only one ruptured aneurysm was dealt with and the outcome was fatal owing to anuria caused by severe haemorrhagic shock. However, we cannot expect an acceptable efficiency level in emergency aneurysmectomy if the diagnostic and therapeutic approach does not guarantee full reliability in cases of elective aneurysmectomy.