Nonresective therapy for aortic aneurysm: results of a survey

We reviewed the experience of 120 vascular surgeons with nonresective therapy for abdominal aortic aneurysm (AAA) in medically unstable patients. Of a total pool of 206 patients, 88 underwent iliac artery ligation, which was combined with angiographic attempts at intrasaccular thrombosis in 80% of cases. The remaining 118 patients had ligation of the aneurysm proximally and distally. In all cases distal perfusion was restored, usually by axillofemoral bypass. Our study demonstrated a significantly higher risk of postoperative AAA rupture (20% vs. 3.3%, p less than 0.0001) and death (34% vs. 5.1%, p less than 0.000001) among patients treated by ligation distal to the AAA alone, whether intrasaccular thrombosis occurred or not. These results support the contention that if nonresective therapy is chosen for the occasional patient deemed too ill to undergo standard AAA resection, AAA exclusion by proximal and distal ligation should be performed.