title: Outcome and risk factor analysis of patients who underwent open infrarenal aortic aneurysm repair.
abstract: BACKGROUND
  The aim of this study was to evaluate the short- and long-term outcomes in patients who underwent open infrarenal aortic aneurysm repair.
  
  
  METHODS
  Consecutive patients who underwent open repair of infrarenal aortic aneurysms at our institution from July 1(st) 1990 to June 30(th) 2012 were reviewed from a prospective collected departmental database. Short-term outcomes included 30-day mortality and peri-operative complications. Independent risk factors to predict 30-day mortality were identified. Long-term survival and secondary interventions were also reported.
  
  
  RESULTS
  Three hundred and eighty-three patients (317 males, median age 72 years with a range of 15-90 years) underwent open infrarenal aortic aneurysm repair during the period, of whom 266 (69.5%) were elective, 18 (4.7%) were urgent for symptomatic but nonruptured cases, and 99 (25.8%) were emergency procedures for ruptured aneurysms. Mean aneurysm size was 6.5 cm (ranging from 2.5 cm to15 cm). All patients were followed up for at least 24 months with a mean follow up period 163 months. Overall 30-day mortality was 11.0% (36.4% for ruptured cases, 11.1% for symptomatic cases, and 1.5% for elective cases; p < 0.001). Preexisting renal disease and ruptured aneurysms were independent risk factors for 30-day mortality (p = 0.001 and p = 0.006 respectively). Systemic complications included 50 cardiac events, 52 respiratory events, six renal events, three cerebral vascular accidents, and one deep vein thrombosis/pulmonary embolism. Local complications included two anastomotic/graft hemorrhage, 10 distal thrombosis/embolisms, five bowel ischemias, one spinal cord ischemia, and 17 wound complications. The ruptured group presented survival rates of 53.5%, 50.5%, 47.5%, 42.3%, 38.0%, 21.9%, and 12.5% at 1 year, 2 years, 3 years, 4 years, 5 years, 10 years, and 15 years, respectively; while nonruptured survival rates were 91.5%, 88.0%, 83.7%, 78.3%, 73.0%, 43.0%, and 25.3%, respectively (log rank p < 0.001). For those who died 30 days after the operation, only six patients (1.8%) died from aneurysm related mortality. A total of three (0.9%) patients underwent late re-interventions, one for late aorto-enteric fistulae and two for anastomotic pseudoaneurysms.
  
  
  CONCLUSIONS
  In the current era of endovascular repair, open infrarenal aneurysm repair is effective and durable, and has very low secondary interventions rates.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Center, Pokfulam, Hong Kong.
authors.forename: Yuk
authors.initials: Y
authors.lastname: Law
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Center, Pokfulam, Hong Kong. Electronic address: ycchan88@hkucc.hku.hk.
authors.forename: Yiu Che
authors.initials: YC
authors.lastname: Chan
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Center, Pokfulam, Hong Kong.
authors.forename: Grace C Y
authors.initials: GC
authors.lastname: Cheung
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Center, Pokfulam, Hong Kong.
authors.forename: Albert Chi Wai
authors.initials: AC
authors.lastname: Ting
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Center, Pokfulam, Hong Kong.
authors.forename: Stephen Wing Keung
authors.initials: SW
authors.lastname: Cheng
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D058017:Vascular Grafting / Q000379:methods; D055815:Young Adult
keywords: abdominal aortic aneurysm; abdominal aortic aneurysm repair; long term survival; reintervention