title: Open repair of infra renal abdominal aortic aneurysms: a single center experience from the developing world.
abstract: BACKGROUND
  In the absence of endovascular aneurysm repair due to financial constraints, Abdominal Aortic Aneurysm (AAA) in Sri Lanka is managed exclusively by open surgery. We report our experience with open AAA repair with emphasis on peri-operative morbidity and mortality.
  
  
  METHODS
  Seventy nine consecutive open AAA repairs were carried out between April 2004 and March 2010. A multiple regression model was used to identify predictors of significant peri-operative morbidity and mortality.
  
  
  RESULTS
  Mean age of the study cohort was 68 years. There were 63 (80%) males and 16 (20%) females. Mean aneurysm diameter was 6.4 (3.5-9.70) cm. Twenty seven (34%) underwent emergency surgical repair (group-1) while 52 (66%) had elective repair (group-2). The peri-operative mortality was 10/27 (37%) in group-1, 4/52 (7.6%) in group-2, (p = 0.0035). Significant post-operative morbidity was seen in 5/17 (29%) in group-1 and 7/48 (15%) in group-2, (p = 0.27). Aneurysm diameter >7 cm (p = 0.001), emergency repair (p = 0.004), history of smoking (p = 0.002), aortic cross-clamp time >60 minutes (p = 0.044), and need for post-operative ventilwation >24 hours (p = 0.024) were found to be independent predictors of peri-operative mortality or significant morbidity.
  
  
  CONCLUSIONS
  Open aneurysm repair still has a strong place especially in the limited resource setting, with acceptable outcomes.
authors.affiliation: Department of Vascular Surgery and Organ Transplantation, National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Nalaka
authors.initials: N
authors.lastname: Gunawansa
authors.forename: Thushan
authors.initials: T
authors.lastname: Goonerathne
authors.forename: Rezni
authors.initials: R
authors.lastname: Cassim
authors.forename: Mandika
authors.initials: M
authors.lastname: Wijeyaratne
keywords: limited resource setting; open aortic aneurysm repair; peri-operative morbidity and mortality
references.citation: J Vasc Surg. 2009 Oct;50(4 Suppl):S2-49
references.pmid: 19786250
references.citation: J Vasc Surg. 2000 Dec;32(6):1091-100
references.pmid: 11107080
references.citation: N Engl J Med. 2008 Jan 31;358(5):464-74
references.pmid: 18234751
references.citation: Eur J Vasc Endovasc Surg. 2008 May;35(5):558-70
references.pmid: 18226567
references.citation: Eur J Vasc Endovasc Surg. 2001 Sep;22(3):197-204
references.pmid: 11506510
references.citation: JAMA. 1992 Nov 18;268(19):2678-86
references.pmid: 1433687
references.citation: Surgery. 1993 Jul;114(1):31-5
references.pmid: 8356523
references.citation: Ann Surg. 2009 Aug;250(2):187-96
references.pmid: 19638912
references.citation: Eur J Vasc Endovasc Surg. 1999 Mar;17(3):208-12
references.pmid: 10092892
references.citation: J Cardiovasc Surg (Torino). 1999 Feb;40(1):1-5
references.pmid: 10221377
references.citation: N Engl J Med. 2002 Apr 11;346(15):1128-37
references.pmid: 11948273
references.citation: J Vasc Surg. 2003 Oct;38(4):739-44
references.pmid: 14560223
references.citation: Surg Clin North Am. 2007 Oct;87(5):1017-33, viii
references.pmid: 17936473
references.citation: Br J Surg. 2002 Jun;89(6):714-30
references.pmid: 12027981
references.citation: J Vasc Surg. 2003 May;37(5):1106-17
references.pmid: 12756363
references.citation: J Am Coll Cardiol. 1989 Nov 1;14(5):1245-52
references.pmid: 2808978
references.citation: J Vasc Surg. 2008 Dec;48(6):1396-400
references.pmid: 18829222
references.citation: J Vasc Surg. 1999 Oct;30(4):632-40
references.pmid: 10514202
references.citation: N Engl J Med. 2003 Nov 27;349(22):2117-27
references.pmid: 14645640
references.citation: J Vasc Surg. 2002 Jun;35(6):1145-54
references.pmid: 12042724
references.citation: J Vasc Surg. 2001 Feb;33(2):345-52
references.pmid: 11174788