Surgical management of 671 abdominal aortic aneurysms: a 13 year review from a single centre

To audit the results for abdominal aortic aneurysm (AAA) repair from a single centre over a 13 year period.

Retrospective survey.

Vascular unit of a major teaching hospital.

Six hundred and seventy-one consecutive patients divided into two groups: group A (1981-87) and group B (1988-93).

Mortality rates, cause of death and major complications in patients undergoing elective, urgent and ruptured AAAs.

Elective repair was performed in 313 (47%) patients, urgent repair in 80 (12%) and emergency repair for rupture in 278 (41%). A vascular surgeon performed the procedure in 94% of patients. The overall mortality was 21 patients in the elective group (6.7%), 13 in the urgent group (16%) and 148 in the ruptured group (53%). Mortality rates have not fallen during the study period but more patients in group B had ischaemic heart disease. Sixty patients (9%) required further operative procedures on 66 occasions: 24 elective cases (8%), 8 urgent cases (10%) and 28 ruptured cases (10%). There were 23 deaths in these 60 patients (38%) who underwent re-operation (5 elective, 2 urgent and 16 ruptured). Major postoperative complications included cardiac events in 212 (32%) patients, respiratory failure in 202 (30%) and renal failure in 90 (13%). Major causes of death included cardiac disease in 67 patients (37%), cardiac disease with coagulopathy in 22 (12%) and cardiac disease with respiratory failure in 16 (9%). Logistic regression analysis showed that in the elective group, cardiac or renal failure were significantly associated with death; and in the ruptured group cardiac, respiratory or renal failure were significantly associated with death.

More high risk patients with ischaemic heart disease are undergoing AAA repair. Postoperative cardiac, respiratory or renal failure are significant causes of death in AAA patients.