Surgery for abdominal aortic aneurysms. With special reference to high-risk patients

Between 1973 and 1980, 150 patients with an abdominal aneurysm underwent aneurysmectomy at St Vincent's Hospital, Sydney. Of these, 52 were high-risk patients with significant medical disease, including myocardial ischaemia, angina pectoris, obstructive airways disease, portal hypertension, and end-stage renal disease. The operative mortality for the 150 patients was 4.6%; it was 9.6% in the high-risk group. The predicted overall survival rate at seven years, with a minimum of two years' follow-up, was 55%, which compares favourably with that reported in other series, particularly in view of the advanced age of most of the patients--43% were in the eighth decade of their lives. The predicted survival rate of 26% for the high-risk group is nearly four times the survival rate predicted by Szilagyi for patients with untreated aneurysms. This increased life expectancy justifies the adoption of the widest possible selection criteria for elective aneurysmectomy.