A personal experience with factors influencing survival after elective open repair of infrarenal aortic aneurysms

Abstract

To investigate risk factors that influence survival after open abdominal aortic aneurysm (AAA) repair in all elective patients treated by a single surgeon at a tertiary referral center. The series includes 855 asymptomatic infrarenal AAAs in 732 men (86%) and 123 women with median ages of 69 and 71 years, respectively. Noninvasive myocardial imaging (n = 325), coronary arteriography (n = 418), or both were performed before surgery in 687 patients (80%), and 100 patients (15%) underwent preliminary coronary artery bypass grafting (n = 78) or percutaneous transluminal coronary angioplasty (n = 22) before their AAA procedures. Survival was assessed by using logistic regression analysis, proportional hazards models, and Kaplan-Meier estimations. The operative mortality rate was 2.5%, ranging only from 1.8% to 2.8% since 1980. Late survival rates (70% at 5 years, 36% at 10 years, and 16% at 15 years) also remained remarkably similar during five arbitrary intervals comprising the entire study period. On multivariable analysis, overall mortality rates were adversely affected by older age (P < .001), increased creatinine levels (P < .001), straight aortic replacement grafting (P < .001), larger aneurysm diameter (P = .036), and chronic obstructive pulmonary disease (P = .012). The risk for any early or late death was favorably influenced by preliminary coronary artery bypass grafting or percutaneous transluminal coronary angioplasty (hazard ratio, 0.76; 95% confidence interval, 0.59-0.98; P = .035) even when a separate multivariable model was fit to accommodate nine other patients who also had preliminary coronary intervention but developed symptomatic AAAs before elective repair could be performed (hazard ratio, 0.78; 95% confidence interval, 0.61-0.99; P = .044). Patient age and medical risk factors determine survival after open AAA repair to a very similar degree irrespective of the era when the operation is performed. In this particular series, preliminary coronary intervention seemed to benefit patients with severe coronary artery disease.