Previous Abdominal Aortic Aneurysm Repair Research Articles

Clinical presentation, operative management, and long-term outcomes of rupture after previous abdominal aortic aneurysm repair

ObjectiveThe aim of the present study was to evaluate the presentation trends, intervention, and survival of patients who had been treated for late abdominal aortic aneurysm rupture (LAR) after open repair (OR) or endovascular aortic aneurysm repair (EVAR). MethodsWe reviewed the clinical data from a single-center, retrospective database for patients treated for LAR from 2000 to 2020. The end points were the 30-day mortality, major postoperative complication, and survival. The outcomes between LAR managed with EVAR (group I) vs OR were compared (group II). ResultsOf 390 patients with infrarenal aortic rupture, 40 (10%) had experienced aortic rupture after prior aortic repair and comprised the LAR cohort (34 men; age 78 ± 8 years). LAR had occurred before EVAR in 30 and before OR in 10 patients. LAR was more common in the second half of the study with 32 patients after 2010. LAR after prior OR was secondary to ruptured para-anastomotic pseudoaneurysms. After initial EVAR, LAR had occurred despite reintervention in 17 patients (42%). The time to LAR was shorter after prior EVAR than after OR (6 ± 4 vs 12 ± 4 years, respectively; P = .003). Treatment for LAR was EVAR for 25 patients (63%; group I) and OR for 15 (37%, group II). LAR after initial OR was managed with endovascular salvage for 8 of 10 patients. Endovascular management was more frequent in the latter half of the study period. In group I, fenestrated repair had been used for seven patients (28%). Salvage for the remaining cases was feasible with EVAR, aortic cuffs, or limb extensions. The incidence of free rupture, time to treatment, 30-day mortality (8% vs 13%; P = .3), complications (32% vs 60%; P = .1), and disposition were similar between the two groups. Those in group I had had less blood loss (660 vs 3000 mL; P < .001) and less need for dialysis (0% vs 33%; P < .001) than those in group II. The median follow-up was 21 months (interquartile range, 6-45 months). The overall 1-, 3-, and 5-year survival was 76%, 52%, and 41%, respectively, and was similar between groups (28 vs 22 months; P = .48). Late mortality was not related to the aorta. ConclusionsLAR after abdominal aortic aneurysm repair has been encountered more frequently in clinical practice, likely driven by the frequency of EVAR. However, most LARs, including those after previous OR, can now be salvaged with endovascular techniques with lower morbidity and mortality.

European Multicentric Experience With Fenestrated-branched ENDOvascular Stent Grafting After Previous FAILed Infrarenal Aortic Repair: The EU-FBENDO-FAIL Registry.

To report the mid-term outcomes of fenestrated-branched endovascular aneurysm repair (F-BEVAR) following a failed previous endovascular aneurysm repair (pEVAR) or previous open aneurysm repair (pOAR). Data from consecutive patients who underwent F-BEVAR for pEVAR or pOAR from 2006 to 2021 from 17 European vascular centers were analyzed. Endpoints included technical success, major adverse events, 30-day mortality, and 5-year estimates of survival, target vessel primary patency, freedom from reinterventions, type I/III endoleaks, and sac growth >5mm. Treatment of a failed previous abdominal aortic aneurysm repair is a complex undertaking. F-BEVAR is becoming an increasingly attractive option, although comparative data are limited regarding associated risk factors, indications for treatment, and various outcomes. There were 526 patients included, 268 pOAR and 258 pEVAR. The median time from previous repair to F-BEVAR was 7 (interquartile range, 4-12) years, 5 (3-8) for pEVAR, and 10 (6-14) for pOAR, P <0.001. Predominant indication for treatment was type Ia endoleak for pEVAR and progression of the disease for pOAR. Technical success was 92.8%, pOAR (92.2%), and pEVAR (93.4%), P =0.58. The 30-day mortality was 6.5% overall, 6.7% for pOAR, and 6.2% for pEVAR, P =0.81. There were 1853 treated target vessels with 5-year estimates of primary patency of 94.4%, pEVAR (95.2%), and pOAR (94.4%), P =0.03. Five-year estimates for freedom from type I/III endoleaks were similar between groups; freedom from reintervention was lower for pEVAR (38.3%) than for pOAR (56.0%), P =0.004. The most common indication for reinterventions was for type I/III endoleaks (37.5%). Repair of a failed pEVAR or pOARis safe and feasible with comparable technical success and survival rates. While successful treatment can be achieved, significant rates of reintervention should be anticipated, particularly for issues related to instability of target vessels/bridging stents.

Clinical Presentation, Operative Management, and Long-Term Outcome of Rupture After Previous Abdominal Aortic Aneurysm Repair

Late abdominal aortic aneurysm rupture (LAR) after open or endovascular repair is uncommon but life-threatening. In the present study, we characterized the presentation trends, intervention, and survival after LAR. We performed a single-center, retrospective study of patients who had undergone LAR repair from 2000 to 2020. The endpoints were 30-day mortality, major postoperative complications, and survival. We compared the outcomes between LAR managed with endovascular aortic aneurysm repair (EVAR; group I) vs open surgical repair (OSR; group II). Of 390 patients with infrarenal aortic aneurysm rupture, 40 (10%) had undergone prior aortic repair and comprised the LAR cohort (34 men; mean age, 78 years; initial EVAR for 29; initial OSR for 11). LAR had occurred despite reintervention in 13 patients (44%). Endoleaks had developed in 26 patients and were type I in 21 patients (72%), type III in 3 patients, (10%) and type II in 2 patients (3%). Ten patients (29%) were lost to follow-up. LAR after prior OSR was secondary to ruptured para-anastomotic pseudoaneurysms, which were managed with endovascular salvage in nine patients. The time to LAR was shorter after prior EVAR compared with after OSR (6 ± 4 vs 12 ± 4 years, respectively; P = .003). Treatment of LAR was EVAR for 27 patients (67%; group I) and OSR for 14 (35%; group II). EVAR was more frequent in the latter one half of the study period (Fig). In group I, fenestrated repair had been used for seven patients (26%). Salvage for the rest was feasible with EVAR, aortic cuffs, or limb extensions. The incidence of free rupture, time to treatment, 30-day mortality, and disposition was similar between the two groups. Those in group I had had less blood loss (660 vs 3000 mL; P < .001) and need for dialysis (0% vs 33%; P < .001) than those in group II. The median follow-up was 20 months (interquartile range, 6-45 months). The 1-, 3-, and 5-year survival was 76%, 52%, and 41%, respectively, and was similar between the two groups (28 vs 22 months; P = .92). LAR after abdominal aortic aneurysm repair has become increasingly common, likely resulting from the frequency of EVAR. Most LARs, including those occurring after previous OSR, can be now be salvaged with endovascular techniques with lower morbidity and mortality.

Early and Long-Term Outcomes of Endovascular Aortic Repair in Young and Low Surgical Risk Patients in the Global Registry for Endovascular Aortic Treatment

Purpose: To investigate early- and long-term outcomes of endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA) in young and low surgical risk patients. Methods: The global registry for endovascular aortic treatment (GREAT) was queried for all patients with AAA undergoing standard EVAR; patients were excluded if had previous AAA repair or underwent concomitant procedures. Young patients were defined if age <60; surgical risk was assessed through the validated Medicare perioperative risk score (MPRS) based on age, sex, renal function, heart failure, and peripheral vascular disease. Patients were classified as low (MPRS<3), average (MPRS 3–11), or high (MPRS>11) risk. Young versus older patients and low-risk versus average/high-risk patients were compared. The primary endpoints were early (30 days) major adverse events (MAEs), 5-year freedom from overall mortality, aortic-related mortality, and freedom from device-related reinterventions. Time-to-event endpoints were calculated by Kaplan–Meier curves. Results: Of 3217 included patients, 182 (6%) were <60 years old, 956 (30%) had a low surgical risk, 1561 (49%) an average risk, 700 (22%) a high risk. Young patients had a less angulated proximal neck (27.2±18.4° vs 30.9±21.5°; p=0.05); in low-risk compared to average/high-risk patients, a longer neck length (3±1.8 vs 2.8±1.4 cm; p=0.01) and lower neck angulation (29.7±21.8° vs 33.2±22.2°; p=0.01) were present. Young age alone had no significant impact on early mortality (0% vs 0.6%; p=0.62.) and MAEs (3.9% vs 6.1%; p=0.20), while these were significantly lower in low-risk compared to average/high-risk patients (early mortality: 0.1% vs 0.7%, p=0.04; MAEs: 4.1% vs 6.7%, p=0.005). At 5 years, overall survival was significantly higher in young (88% vs 76%; p<0.001) and lower-risk (77% vs 54%; p<0.001) patients; low-risk patients also had significantly decreased aortic-related mortality (0% vs 2%; p=0.04) and reintervention rates (6% vs 11%; p=0.007). There were no statistically significant differences in mortality (0% vs 2%; p=0.42) and reintervention rate (10% vs 10%; p=1.00) between young and older patients. Conclusion: In this real-world registry, EVAR was more often offered in cases with suitable anatomy in young and low-risk patients. Low operative risk, rather than young age alone, predicted excellent early outcomes and low 5-year mortality, aortic-related mortality, and reintervention rates.

Incidence of thoracic aortic aneurysms in patients with a previous abdominal aortic aneurysm repair.

Incidence of thoracic aortic aneurysms in patients with a previous abdominal aortic aneurysm repair.

Discussion

Discussion

Two cases of aortoenteric fistula with gastrointestinal bleeding.

Aortoenteric fistula (AEF) is a life-threatening condition that can present with gastrointestinal (GI) bleeding. AEFs have been classified into primary and secondary types. Primary AEF (PAEF) is a direct communication between the aorta and the GI tract. Secondary AEF (SAEF) is the result of a previous abdominal aortic aneurysm repair involving placement of a synthetic aortic graft. Diagnosis of AEF, especially PAEF, is difficult largely because AEF is so rarely encountered in practice. Computed tomography (CT) and endoscopic gastroduodenoscopy (EGD) are most frequently used to diagnose AEF, with abdominal contrast-enhanced CT being the preferred initial diagnostic test of choice. Although EGD can exclude other common causes of GI hemorrhage, it cannot be used to rule out AEF when another source of bleeding is identified, as the two conditions can coexist. We discuss here two patients with GI bleeding who were diagnosed as PAEF and SAEF. We tried to diagnose and treat with EGD, but failed. That bleeding was due to an AEF became evident when abdominal CT scans revealed direct extravasation of contrast media from the abdominal aorta into the GI tract. The lack of awareness of AEF, coupled with the inaccessibility to the distal duodenum via EGD, were probably responsible for initial misdiagnosis and delay of appropriate management. We suggest that the diagnosis of AEF remains dependent on the clinician's heightened suspicion.

Hybrid aortic arch repair.

Innovations in thoracic endovascular aortic repair techniques have enabled its incorporation in open procedures, resulting in a hybrid approach to aortic arch repair. The present study reported our experience with the hybrid technique in managing arch pathologies. Fifty-one patients underwent a hybrid repair of arch pathologies. 10 patients had urgent or emergency surgery, and 8 had previous abdominal aortic aneurysm repair; all were classified as high risk (ASA grade III or IV). Overall 30-day mortality was 9.8% (5/51). Hospital mortality was 30% (3/10) in urgent/emergent surgery and 4.90% (2/41) in elective cases. Ischemic stroke occurred in 11.8% (6/51) of patients, while 5.9% (3/51) experienced paraplegia. Endoleaks occurred in 8 patients, 6 of which were Type 1. Long-term patency rate was 96%. The hybrid technique is a safe, effective and less invasive alternative to open repair of arch pathologies, with comparable outcomes in high-risk patient groups. Patency rates and durability demonstrate the long-term potential of this technique.

Infradiaphragmatic malperfusion of acute aortic dissection associated with previous abdominal aortic aneurysm repair

To evaluate the association of previous abdominal aortic aneurysm (AAA) graft replacement with infradiaphragmatic malperfusion in patients with acute aortic dissection. Between November 2006 and June 2011, 133 patients were referred to our hospital for management of acute aortic dissection. Eight (6.0 %) of these patients had undergone AAA graft replacement prior to the acute aortic dissection. We compared the computed tomography (CT) images of these 8 patients with those of the remaining 125 patients without previous AAA graft replacement, in terms of organ ischemia as a complication induced by acute aortic dissection. Infradiaphragmatic malperfusion from acute aortic dissection was confirmed in four of the eight patients who had undergone AAA graft replacement. Contrasted CT scan images indicated that the main cause of infradiaphragmatic malperfusion was collapse of the true lumen from compression by the false lumen into the suprarenal aorta. Although there was no significant difference between the groups in terms of cerebral ischemia and myocardial ischemia, bilateral leg ischemia and visceral ischemia occurred more frequently in the patients who had undergone AAA graft replacement. Previous AAA graft replacement is a risk factor for infradiaphragmatic malperfusion in patients with acute aortic dissection.

Severe Limb Ischemia Related to Previous Abdominal Aortic Aneurysm Repair Induced by Acute Aortic Dissection

We described the first case of limb ischemia induced by acute aortic dissection in the patient with previous abdominal aortic aneurysm (AAA) repair. A 56-year-old male was referred for severe limb ischemia. He underwent AAA repair one month before the referral. Computed tomography (CT) scan revealed Stanford type B aortic dissection extended to the proximal anastomosis site of the AAA repair. The false lumen made the complete interruption of antegrade blood flow at the proximal anastomosis site of the AAA repair.

Effectiveness of intensive medical therapy in type B aortic dissection: A single-center experience

Although the mainstay of managing acute descending thoracic aortic dissection (ADTAD) remains medical, certain patients will require emergency surgery for complications of rupture or ischemia. This study evaluates factors that affect outcome and determines which patients previously treated surgically would have been eligible for endovascular repair. A single-institution retrospective study was conducted of patients who presented with clinical signs of ADTAD that was confirmed by magnetic resonance angiography (MRA) or computed tomography (CT). All patients were admitted to the intensive care unit (ICU) and medically managed to maintain systolic blood pressure<120 mm Hg and heart rate<70 beats/min. Two treatment groups were identified: group 1 received medical treatment only; group 2 received medical treatment plus emergency surgery. Patient demographic and clinical data were correlated with 30-day group mortality and morbidity and need for emergency surgery. The MRA and CT scan images of group 2 were retrospectively reviewed to determine if currently available endovascular treatment could have been done. The Fisher exact test was used to compare between the groups, and P<.05 was considered significant. Between 1991 and 2005, 83 patients (55 men) were treated for ADTAD. The mean age was 67 years (range, 38 to 85). Sixty-eight patients (82%) had hypertension, three (3.6%) had Marfan syndrome, and 51 (62%) were smokers. Twenty-five (32%) of the patients were receiving beta-blocker therapy before the onset of their symptoms. Back pain was the most common initial symptom (72.2%). Emergency surgery was required in 19 patients (23%): 12 for rupture or impending rupture, four for mesenteric ischemia, and three for lower extremity ischemia. The need for emergency surgery was significantly higher in smokers (P=.03), in patients>70 years old (P=.035), and in patients who were not receiving beta-blocker therapy before the onset of symptoms (P=.023). The combined overall morbidity rate was 33%, and the mortality rate was 9.6%. Morbidity in group 2 was 64% and significantly higher than the 23% in group 1 (P=.00227). The mortality rate was also higher in group 2 at 31.5% compared with group 1 at 1.6% (P=.0004). Factors affecting the overall mortality included age>70 years (P=.057), previous abdominal aortic aneurysm repair (P=.018), tobacco use (P=.039), and the presence of leg pain at initial presentation (P=.013). As determined from the review of radiologic data, 11 of 13 patients with scans available for review in group 2 could have been treated with currently available endovascular grafts. Intensive medical therapies are effective in preventing early mortality associated with ADTAD. Predictably, the need for emergency surgery carries a high morbidity and mortality rate. Most patients in this series requiring emergency surgery could have been candidates for endovascular therapy had it been available.

Risk of Spinal Cord Injury After Operations of Recurrent Aneurysms of the Descending Aorta

Degenerative disease of the aorta usually involves the occlusion of several intercostal and lumbar branches by mural thrombus or atherosclerotic plaques, suggesting that the blood supply to the spinal cord is mainly provided through collateral networks. Patients with previous abdominal aortic aneurysm repair and subsequent thoracoabdominal aortic reconstruction must undergo ligation of a number of these segmental arteries, presenting a greater risk of experiencing spinal cord ischemic injury. The records of 18 patients who had experienced abdominal aortic aneurysm graft replacement and who had undergone 19 operations for thoracoabdominal aortic repair were retrospectively evaluated. All patients were male. The mean age was 66 +/- 10 years (range, 36 to 75 years); the mean interval between the two operations was 79 +/- 69 months (range, 1 to 231 months). There were 18 (95%) cases of thoracoabdominal aortic aneurysms, and one (5%) case of acute dissection of the thoracoabdominal aorta. The origin of the Adamkiewicz artery was determined preoperatively by computed tomography. Measures to avoid spinal cord injury included monitoring of evoked spinal cord potentials and selective reconstruction of the intercostal arteries under hypothermic cardiopulmonary bypass. There were three (16%) cases of permanent neurologic injury that included one cerebrovascular accident, one neurogenic bladder, and one paraparesis of the right lower limb. There were no cases of paraplegia or postoperative deaths. Surgical reconstruction of the thoracoabdominal aorta in patients who previously underwent abdominal aortic graft replacement is not related to an increased probability of developing spinal cord ischemic injury.

INVITED COMMENTARY

INVITED COMMENTARY

Thoracovisceral segment aneurysm repair after previous infrarenal abdominal aortic aneurysm surgery

Objective Repair of thoracovisceral aortic aneurysms (TVAA) after previous open repair of an infrarenal abdominal aortic aneurysm (AAA) poses significant challenges. We sought to better characterize such recurrent aneurysms and to evaluate their operative outcome. Methods We reviewed the records and radiographs of 49 patients who underwent repair of TVAAs between 1988 and 2002 after previous repair of an AAA. Visceral artery reconstructions were completed with combinations of beveled anastomoses, inclusion patches, and side arm grafts. In 14 patients visceral endarterectomy was required to treat associated occlusive disease. Sixteen patients had cerebrospinal fluid drainage, and 10 patients had distal perfusion during cross-clamping. Results Patient mean age was 72 years, and 80% were men. Fifty-one percent of patients had symptomatic disease, and average TVAA diameter was 6.2 cm. Mean time between AAA and TVAA repair was 77 months. Twenty-six percent of aneurysms were restricted to the lower visceral aortic segment, 35% extended to the diaphragm, another 35% extended to the distal or middle thoracic aorta, and 4% involved the entire remaining visceral and thoracic aorta. The 30-day operative mortality rate was 4.1% in patients with nonruptured aneurysms and 50% in patients with ruptured aneurysms, for an overall mortality rate of 8.2%. Fifteen patients (30.6%) had major morbidity, including paresis in two patients and dialysis-dependent renal failure in five patients. At late follow-up, three patients required further aortic operations to treat additional aneurysms, and four patients had fatal aortic ruptures. Two-year and 5-year cumulative survival rates were 61% (±7.5%) and 37% (±7.8%), respectively. At univariate analysis, operative blood loss was the sole significant predictor of major morbidity ( P < .023), and rupture ( P < .030, P < .0001) and aneurysm extent ( P < .0007, P < .0001) correlated with both operative death and long-term survival. Only aneurysm extent ( P < .010, relative risk 37.3) remained a significant predictor of long-term survival at multivariate analysis. Conclusion Elective repair of TVAAs after previous AAA repair can be performed with an acceptable level of operative mortality, though with considerable operative morbidity. Limited long-term survival mandates careful patient selection, and the high mortality associated with ruptured TVAA underscores the need for post-AAA surveillance.

Type III Thoracoabdominal Aortic Aneurysm Repair: A Combined Surgical and Endovascular Approach

Thoracoabdominal aortic aneurysm (TAAA) repair is a high-risk procedure and thoracic endovascular stenting has encouraging morbidity and mortality. We report a case of Type III TAAA repair in a patient with previous abdominal and thoracic aortic surgery, using a combined surgical and endovascular approach. This innovative method is a particularly attractive option in ‘redo’ operations such as this since it significantly reduces the extent of dissection and avoids thoracotomy.

Screening for abdominal aortic aneurysm reduced death from AAA in older men

(2002) Lancet 360, 1531. The Multicentre Aneurysm Screening Study Group. . The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a...

Risk of spinal cord ischemia after endograft repair of thoracic aortic aneurysms

Background: Surgical repair of thoracoabdominal aneurysms may be associated with a significant risk of perioperative morbidity including spinal cord ischemia, which occurs at a rate of between 5% and 21%. Spinal cord ischemia after endovascular repair of thoracic aortic aneurysms (TAAs) has also been reported. This investigation reviews the occurrence of spinal cord ischemia after endovascular repair of descending TAAs at the Mount Sinai Medical Center. Patients and Methods: Between May 1997 and April 2001, 53 patients underwent endovascular exclusion of their TAA. Preprocedure computed tomography scanning and angiography were performed on all patients. All were performed in the operating room using C-arm fluoroscopy. Physical examinations and computed tomography scans were performed at discharge and at 1, 3, 6, and 12 months postoperatively and then annually thereafter. Spinal cord ischemia developed in three of the 53 patients (5.7%) postoperatively. In one patient, cord ischemia developed that manifested as early postoperative left leg weakness occurring after concomitant open infrarenal abdominal and endovascular TAA repair. The neurologic deficit resolved 12 hours after spinal drainage, steroid bolus, and the maintenance of hemodynamic stability. The remaining two patients developed delayed onset paralysis, one patient on the second postoperative day and the other patient 1 month postrepair. Both of these patients had previous abdominal aortic aneurysm repair, and both required long grafts to exclude an extensive area of their thoracic aortas. Irreversible cord ischemia and paralysis occurred in both of these patients. Conclusions: Endovascular repair of TAA has shown a promising reduction in operative morbidity; however, the risk of spinal cord ischemia remains. Concomitant or previous abdominal aortic aneurysm repair and long segment thoracic aortic exclusion appear to be important risk factors. Spinal cord protective measures (ie, cerebrospinal fluid drainage, steroids, prevention of hypotension) should be used for patients with the aforementioned risk factors undergoing endovascular TAA repair. (J Vasc Surg 2001;34:997-1003.)

Aortic rupture presenting with hemoptysis

A 60-year-old man with a history of previous abdominal aortic aneurysm repair presented to an outside hospital with acute onset of left-sided chest pain for 5 hours. On admission he was hypotensive with intact peripheral pulses and no cardiac murmurs. Shortly after arrival he had hemoptysis prompting intubation for airway control and pulmonary toilet. Computed tomography of the chest (Figs 1 and 2) was interpreted as demonstrating an acute aortic dissection. The patient was transferred to our institution for surgical treatment. On arrival the patient was hypotensive requiring pressor support. Our radiologist reviewed the computed tomographic scan, confirming aortic dissection and noting thickening of the walls of the pulmonary arteries.

RENAL ARTERY THROMBOSIS SECONDARY TO URETERAL OBSTRUCTION

Nephrolithiasis in patients with a solitary kidney can cause obstructive anuria. However, to our knowledge we report the first case of renal artery bypass graft thrombosis after acute ureteral obstruction in a solitary functioning kidney presenting with anuria. We propose that myogenically mediated renal artery hypoperfusion secondary to acute ureteral obstruction, with blood pooling at the renal artery anastomotic site of a previous abdominal aortic aneurysm repair, was responsible for the thrombotic event. Physiological evidence concerning renal artery hemodynamics in acute ureteral obstruction is reviewed.

Isolated iliac artery aneurysms in patients with or without previous abdominal aortic aneurysm repair

Background: Isolated iliac artery aneurysms (IAA) in patients with or without previous abdominal aortic aneurysm (AAA) repair are rare. We wanted to compare the presentation, distribution, treatment, outcome and patterns of subsequent aneurysm formation in these patients. Methods: We retrospectively reviewed patients with isolated IAA over a 10-year period. Patients with primary isolated IAA (group 1) were compared with patients who presented with IAA after previous AAA repair (group 2). Results: There were 23 patients in each group. Demographics and comorbidities were similar. No aneurysms were detected outside of the iliac system in group 1; 22% of patients in group 2 had other aneurysms. The mean time after AAA repair to IAA diagnosis was 8.8 ± 3.2 years for operated on patients. The in-hospital mortality was 0% for elective cases and 50% for emergency cases for both groups. Three patients in group 2 (13%) developed new aneurysms during follow-up, whereas the only new aneurysm in group 1 was a contralateral IAA. Conclusions: Patients with new IAA after AAA repair have a greater tendency to develop further aneurysms in other sites, synchronously or metachronously. The time to detection of new IAA after AAA repair is at least 5 years in most cases. In both groups, a quarter to a third of patients present with rupture, with a resultant mortality of 30% to 50%, whereas those operated on electively have minimal morbidity and almost no mortality.