title: Surgical treatment of abdominal aortic aneurysms associated with aortic valve incompetence: strategies and outcomes.
abstract: BACKGROUND
  The exact incidence of associated aortic valve incompetence (AVI) and abdominal aortic aneurysm (AAA) in the general population is not known. In recent years, we have observed this association with increasing frequency. This observation is probably due to the extensive preoperative screening of the cardiac and vascular status of patients who are candidates for surgical procedures. The choice of the optimal surgical strategy is needed to achieve low operative morbidity and mortality. The present study reviews our experience with a subset of patients suffering the association of AVI and large AAA. Surgical strategy, clinical management and outcome are presented.
  
  
  METHODS
  Between January 1982 and May 2000, 76 patients with the association of AAA and AVI have been evaluated in our institution. Forty-four patients have been treated for both AAA and aortic valve (AV) regurgitation. These patients have been divided into three groups on the basis of the surgical strategy adopted. Group 1: combined procedure (16 patients); group 2: AAA repair prior to AV surgery (nine patients); group 3: AV surgery prior to aneurysm repair (19 patients).
  
  
  RESULTS
  Hospital mortality was 4.5% (two patients); overall mortality was 6.8% (three patients).
  
  
  CONCLUSIONS
  In patients with AAA and AVI, an accurate and complete preoperative evaluation is essential. Surgical strategy should be individualized on the basis of the cardiac preoperative status.
authors.affiliation: Istituto di Chirurgia Toracica, Cardiovascolare Universita' agli Studi di Siena, Viale M Bracci Policlinico le Scotte, Italy. euxneri@tin.it
authors.forename: E
authors.initials: E
authors.lastname: Neri
authors.forename: T
authors.initials: T
authors.lastname: Toscano
authors.forename: M
authors.initials: M
authors.lastname: Massetti
authors.forename: G
authors.initials: G
authors.lastname: Frati
authors.forename: D
authors.initials: D
authors.lastname: Buklas
authors.forename: E
authors.initials: E
authors.lastname: Tucci
authors.forename: G
authors.initials: G
authors.lastname: Capannini
authors.forename: S
authors.initials: S
authors.lastname: Mondillo
authors.forename: A
authors.initials: A
authors.lastname: Picchi
authors.forename: F
authors.initials: F
authors.lastname: Guerrini
authors.forename: C
authors.initials: C
authors.lastname: Sassi
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods