title: Outcomes of symptomatic abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Operative mortality of patients undergoing symptomatic abdominal aortic aneurysm (Sx-AAA) repair has been reported at 6% to 30% during the past 25 years. We used a multicenter regional database to describe the contemporary outcomes of patients undergoing repair of Sx-AAA.
  
  
  METHODS
  All patients undergoing infrarenal AAA repair in 11 hospitals comprising the Vascular Study Group of Northern New England (VSGNNE) between 2003 and 2009 were studied. Sx-AAA was prospectively defined as an AAA accompanied by abdominal or back pain or tenderness, but without rupture. The primary study end point was in-hospital mortality. Secondary end points included in-hospital postoperative major adverse events (MAE) and late survival. These outcomes were compared between symptomatic patients and contemporary VSGNNE cohorts of elective (E-AAA) and ruptured AAAs (R-AAAs) treated within the same study period.
  
  
  RESULTS
  During the study period, 2386 AAA repairs were performed, comprising 1959 (82%) E-AAAs, 156 (7%) Sx-AAAs, and 271 (11%) R-AAAs. Repair was endovascular in 945 (48%) E-AAAs, 60 (38%) Sx-AAAs, and 33 (12%) R-AAAs. Hospital mortality was 1.7% for E-AAA repair and 1.3% for Sx-AAA repair, but was 34.7% for R-AAA repair (P < .001). The MAE rates were 20%, 35%, and 63%, respectively, for E-AAA, Sx-AAA, and R-AAA repairs (P < .001). The mean Glasgow Aneurysm Score (GAS) for Sx-AAA patients who survived was 79 +/- 12. Those who died had an average score of 92 +/- 7, and 83% of all Sx-AAA and R-AAA patients who died had a GAS >85. Kaplan-Meier analysis demonstrated that at 1 and 4 years, Sx-AAA repair was associated with intermediate survival (83% and 68%) compared with E-AAA repair (89% and 73%) and R-AAA repair (49% and 35%; P < .001).
  
  
  CONCLUSIONS
  The operative mortality of patients with Sx-AAA in contemporary practice appears better than that previously reported in the literature. Despite low operative mortality, MAE and late survival are intermediate compared with E-AAA and R-AAA repair. Review of previous series shows a trend for lower operative mortality after Sx-AAA repair in more recent series, which likely reflects improved perioperative care and more use of endovascular aneurysm repair.
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
authors.forename: Randall R
authors.initials: RR
authors.lastname: De Martino
authors.forename: Brian W
authors.initials: BW
authors.lastname: Nolan
authors.forename: Philip P
authors.initials: PP
authors.lastname: Goodney
authors.forename: Catherine K
authors.initials: CK
authors.lastname: Chang
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.forename: Robert
authors.initials: R
authors.lastname: Cambria
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bertges
authors.forename: Jack L
authors.initials: JL
authors.lastname: Cronenwett
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001416:Back Pain / Q000209:etiology; D016009:Chi-Square Distribution; D019992:Databases as Topic; D017558:Elective Surgical Procedures; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009511:New England; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
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