Outcomes of symptomatic abdominal aortic aneurysm repair.
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.
De Martino
Randall R
RR
Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.
Nolan
Brian W
BW
Goodney
Philip P
PP
Chang
Catherine K
CK
Schanzer
Andres
A
Cambria
Robert
R
Bertges
Daniel J
DJ
Cronenwett
Jack L
JL
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
Eur J Vasc Endovasc Surg. 2007 Mar;33(3):272-6
17097900
Cardiovasc Surg. 1994 Feb;2(1):41-4
8049922
Ann Vasc Surg. 1994 Mar;8(2):121-6
8198944
Eur J Vasc Endovasc Surg. 1995 Oct;10(3):338-41
7552535
Arch Surg. 1980 Jan;115(1):51-3
7350886
Eur J Vasc Endovasc Surg. 1997 Mar;13(3):322-7
9129607
J Vasc Surg. 2006 Dec;44(6):1156-1161
17055694
J Cardiovasc Surg (Torino). 1991 Sep-Oct;32(5):636-42
1939327
J Vasc Surg. 2007 Dec;46(6):1093-1101; discussion 1101-2
17950568
Scand Cardiovasc J. 2008 Jun;42(3):178-81
18569949
Arch Surg. 1981 Aug;116(8):1025-9
7259506
Eur J Vasc Endovasc Surg. 2009 Sep;38(3):278-84
19540779
Ann Surg. 1999 Sep;230(3):289-96; discussion 296-7
10493476
Ann Chir Gynaecol. 1999;88(1):38-43
10230681
Eur J Vasc Endovasc Surg. 2006 Apr;31(4):345-50
16439168
Ann Surg. 1996 Oct;224(4):501-6; discussion 506-8
8857854
J Vasc Surg. 1990 Jun;11(6):799-803
2359191
BMJ. 2004 Nov 27;329(7477):1259
15545293
Br J Surg. 1998 May;85(5):645-7
9635812
Scand Cardiovasc J. 2005 Apr;39(1-2):91-5
16097421
J Hosp Med. 2007 Jul;2(4):241-52
17702038
J Cardiovasc Surg (Torino). 1987 Mar-Apr;28(2):167-70
3558465
Eur J Vasc Endovasc Surg. 1997 Nov;14(5):375-9
9413378