Management of abdominal aortic aneurysm

Area of Science:

• Vascular Surgery
• Surgical Outcomes
• Infectious Disease in Surgery

Background:

• Abdominal aortic aneurysm (AAA) repair is a major surgical undertaking with significant associated risks.
• Historically, outcomes for ruptured or leaking AAAs were poor, and graft infection remains a serious complication.
• Evolving surgical techniques and perioperative care have aimed to improve patient survival and reduce complications.

Purpose of the Study:

• To evaluate the outcomes of surgical repair for abdominal aortic aneurysms over a 9-year period.
• To assess the impact of changing surgical techniques, specifically the inlay graft, on mortality.
• To determine the incidence and impact of early graft infection and the role of perioperative antibiotics.

Main Methods:

• Retrospective analysis of 245 patients undergoing abdominal aortic aneurysm surgery between 1969 and 1977.
• Comparison of outcomes between elective and emergency (leaking/ruptured) cases.
• Evaluation of surgical techniques (excision-replacement vs. inlay grafts) and the use of perioperative antibiotics.

Main Results:

• Hospital mortality for leaking/ruptured aneurysms decreased from 77% to 30% over the study period.
• Elective AAA repair had an average hospital mortality of 9.3%, with no deaths in the final 51 cases.
• Early graft infection occurred in 3.7% of patients (9 deaths), predominantly in the inlay graft group without perioperative antibiotics (8/9 deaths).

Conclusions:

• The inlay technique for abdominal aortic aneurysm repair, while used more frequently, was associated with higher rates of early graft infection.
• Perioperative antibiotic prophylaxis was strongly associated with a reduction in early graft infections.
• Routine use of perioperative antibiotics for arterial prosthetic graft patients was implemented in July 1976 due to these findings.