[Treatment of abdominal aortic aneurysms in chronic hemodialysis]

The aims of the study were 1. To describe the special features of the surgical treatment of abdominal aortic aneurysms in hemodialysis patients and of the perioperative care and 2. To study the results of this treatment and the long-term survival of these patients.

A retrospective study of the author's series was undertaken. Thirty-three patients were operated on for abdominal aortic aneurysms. The 30 male and three female patients ranged in age from 39 to 78 years (mean: 55.3). Eighty percent of the patients were operated on during the first five years following the beginning of maintenance hemodialysis. Preoperative assessment of patients' condition was usual. All patients were operated on from six to 18 hours after a dialysis. The surgical repairs consisted of short prostheses, whenever possible, so as not to make subsequent renal transplantation more difficult. Hemodialysis was resumed on the day of surgery in a few patients or later, according to the level of kaliemia.

Postoperative mortality was 9% and morbidity 18%. Secondary or late vascular operations were required in 10 patients (30%). Only eight patients (24%) underwent secondary renal transplantation. The long-term survival rate was 43% at five years and 11% at ten years. Late deaths were due to coronary artery disease or to worsening of arterial lesions in the lower limbs.

The vascular risks are increased in dialysis patients and their arterial lesions are especially severe. The surgical treatment is not different from that performed in non dialysed patients. Mortality and morbidity are acceptable. The long-term prognosis is poor.