Abdominal aortic aneurysms. Factors influencing operative mortality and criteria of operability.

Abstract

One hundred abdominal aortic aneurysm resections were performed without regard to aneurysmal size. There were three deaths after 87 elective resections and two deaths after 13 ruptured aneurysms. Mortality has decreased (3.4% elective, 15% ruptured) even though average age and associated vascular disease has remained the same or increased. Simplified techniques including intramural removal of the aneurysm, increased use of straight tube grafts, and special respiratory and renal supporting teams appear to have been the major factor in improved survival rates. No deaths were caused by renal failure and only one by hemorrhage related to operation. Death rates in ruptured abdominal aortic aneurysm are limited by the existing myocardial and renal damage at or before the time surgical therapy is instituted. The data suggest that elective surgical resection of all aneurysms without regard to size will increase life expectancy in the five-year postoperative period but that late survival is dependent upon coexisting cardio-cerebrovascular disease.