Mortality following elective infrarenal aortic reconstruction: a Joint Vascular Research Group study

This study aimed to define the cause of death in patients undergoing elective infrarenal aortic reconstruction.

Members of the Joint Vascular Research Group who had collected details prospectively of patients undergoing elective aortic reconstruction provided information on those who died.

Details of 3786 patients were obtained. Some 171 patients died (133 following abdominal aortic aneurysm (AAA) and 38 after aortofemoral bifurcation graft (AFBG) for occlusive disease). The mortality rate following AAA repair was 4.8 per cent, rising to 16 per cent if repair was combined with either renal or distal reconstruction (P < 0.001). Similar results were obtained with AFBG (3.4 and 11 per cent respectively, P < 0.001). The first major complication encountered was cardiac (39.8 per cent), followed by bleeding (20.5 per cent), respiratory (13.5), and gut (5.3 per cent), or limb ischaemia (6.4 per cent). Bleeding was commoner following reconstruction for aneurysm compared with that for occlusive disease (P < 0.05). Eighty-six patients (50.3 per cent) died from the first major complication. Of the remainder, 45 (53 per cent) developed multisystem organ failure (MSOF). The most commonly involved systems were cardiac, respiratory and renal.

Cardiac problems were the major cause of death following infrarenal aortic reconstruction. MSOF is the 'final common pathway' in about half of the patients who survive the initial complication.