Early and long-term results after surgical treatment of abdominal aortic aneurysm

From 1959 to July 1981, 121 patients underwent surgery for abdominal aortic aneurysm. One hundred-nine patients were male and 12 female. Ninety-one patients had an elective operation, 30 patients were operated on an emergency basis. Among the electively treated there were 32 asymptomatic patients. Early mortality of electively operated patients was 13.2% in period I (1959 to 1974), and 8.8% in period II (1975 to 1981). The early death rate of asymptomatic patients decreased from 9.4% to 4.8%. The prognosis of emergency patients remained unchanged: 50% died in both periods. Cardiac complications were the major cause of early death. The late complication rate related to the aneurysmectomy was 18.1%. Four patients died of rupture of the proximal anastomosis. Aneurysm-related reoperations were necessary in 19.1% of the patients. The mortality rate for patients under 65 years was 6.1% in period II, and 16.7% in patients over 70 years. Another severe risk factor is coronary artery disease (16.0% mortality in period II), especially in combination with advanced age (21.4% mortality in period II). The results indicate that the abdominal aortic aneurysm should be treated electively; however, poor risk patients should not undergo surgery if the aneurysm is asymptomatic. In younger patients with coronary artery disease, coronary artery bypass surgery should be considered prior to aneurysmectomy.