Durability of open repair of infrarenal abdominal aortic aneurysm: a 15-year follow-up study.
OBJECTIVE
This study reviewed the long-term outcome of patients who underwent open repair of infrarenal abdominal aortic aneurysms (AAAs).


METHODS
A retrospective study of 208 patients (188 men and 20 women) with a mean age of 65.6 years who survived elective or emergency open repair of an infrarenal AAA was conducted at a university referral hospital. Main outcome measures included late graft-related complications, survival free from any reintervention, survival free from any vascular reintervention, and overall survival rates.


RESULTS
Late graft-related complications occurred in 32 patients (15.4%). A proximal para-anastomotic pseudoaneurysm developed in six patients (2.9%), and a distal pseudoaneurysm developed in 18 patients (8.7%); in seven of these cases (3.4%), it was bilateral or recurrent. A graft limb occlusion occurred in 11 patients (5.3%). These complications required 37 surgical or other invasive procedures in 27 patients (13.0%). Thirty-one vascular and/or endovascular reoperations were performed. The 5-year, 10-year, and 15-year survival free from any reintervention rates were 91.5%, 86.2%, and 72.0%, respectively. At the same intervals, the survival free from any vascular reintervention rates were 93.8%, 88.5%, and 73.9%, respectively, and the overall survival rates were 66.8%, 39.4%, and 18.0%, respectively. Complications associated with a ruptured femoral artery pseudoaneurysm, a ruptured aortic pseudoaneurysm, an aortoduodenal fistula, and the elective repair of a femoral pseudoaneurysm were the graft-related causes of death, which occurred in four patients (1.9%). Age (P <.0001) and chronic obstructive pulmonary disease (P =.002) were shown by means of multivariate analysis to be predictive of poor survival outcome, and chronic obstructive pulmonary disease (P =.02) and lower limb ischemia (P =.04) were shown to be associated with an increased need for vascular reinterventions to treat graft-related complications.


CONCLUSIONS
Open repair of infrarenal AAAs can achieve satisfactory 15-year follow-up rates of survival free from reintervention for any graft-related complications, suggesting that surgery should still be considered the procedure of choice for infrarenal AAAs, at least in patients who are fit for surgery.
Biancari
Fausto
F
Department of Cardiothoracic and Vascular Surgery, Oulu University Hospital, 90221 Oulu, Finland.
Ylönen
Kari
K
Anttila
Vesa
V
Juvonen
Jukka
J
Romsi
Pekka
P
Satta
Jari
J
Juvonen
Tatu
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation; D012044:Regression Analysis; D012077:Renal Artery / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome