[Abdominal aortic aneurysm: course of morbimortality of elective surgery in 20 years]

Abdominal aortic aneurysms (AAA) usually undergo progressive dilatation and eventually may rupture, complication that carries a high mortality rate. If certain clinical conditions, like operative risk and aortic diameter are met, all patients should be considered for surgical repair. Analysis of our results with the surgical treatment of asymptomatic AAA prompted this study. Out of 479 consecutive patients operated because of AAA between 1976 and 1995, 378 (79%) were electively treated. Two decades: 1976-85 (101 patients) and 1986-95 (277 patients) were compared as far as associated medical conditions, surgical procedures, complications and mortality rate. There was no difference in age, sex, risk factors and aortic diameter. During the second decade we favoured the use of aortic tube grafts (53% vs 25%, p < 0.01) and epidural anesthesia (94% vs 35%, p < 0.01). During the last decade only 53.3% of the patients received blood transfusion, compared to 95.3% during the first period (p < 0.001). Operative mortality decreased from 5.94% to 0.72% (p < 0.05). Postoperative hospital stay diminished from 11.2 +/- 8.2 to 9.6 +/- 6.3 days (p < 0.05). These results compare favourably with those reported from other academic centers and support our therapeutic approach. Our contemporary surgical results serve as a reference for future clinical evaluation of endovascular procedures currently under investigation.