Abdominal aortic aneurysm resection--operative risk and long-term results

The aim of the study was to assess the early results of abdominal aortic aneurysm resection in relation to cardiac and other operative risk factors, assess the magnitude of the procedure, and evaluate longer-term postoperative rehabilitation; 176 patients (mean age 67,1 years) were assessed, of whom 160 (90,9%) had operations. Using the multifactorial index of cardiac risk in non-cardiac surgical procedures (Goldman) the majority fell into the low-risk category (groups I and II). Other risk factors evaluated were respiratory disease, renal insufficiency, hypertension and diabetes. The majority of these patients had creatinine clearance rates of less than 50% of the theoretical normal rate for age. Of 7 postoperative deaths (operative mortality rate 4,4%) 4 followed myocardial infarction, and all the latter patients fell into cardiac risk grade III. The other risk factors did not significantly influence the mortality or complication rates. The highest complication rate occurred in patients who underwent aortic bifurcation graft placement and the lowest in patients who underwent simple infrarenal tube grafting. Of 153 survivors, 10 have been lost to follow-up and 141 have returned to full activity. In conclusion, the cardiac risk index used is a valuable predictor of operative risk. If the patient survives surgery, excellent longer-term rehabilitation can be expected.