title: A personal experience with factors influencing survival after elective open repair of infrarenal aortic aneurysms.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Vascular Surgery, the Cleveland Clinic Foundation, OH 44195, USA. hertzen@ccf.org
authors.forename: Norman R
authors.initials: NR
authors.lastname: Hertzer
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Mascha
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D003327:Coronary Disease / Q000150:complications / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000401:mortality*