What Are the Longterm Results of Conventional Open Surgical Repair of Abdominal Aortic Aneurysms ?

Abstract

Purpose : To determine the longterm results of conventional open surgical repair of abdominal aortic aneurysms (AAAs) and the prevalence of late arterial abnormalities.

Methods : CT scan follow-up was obtained between 8 and 9 years after elective AAA repair on a cohort of patients enrolled in the Canadian Aneurysm Study, a registry that originally consisted of 680 patients. A request for CT follow- up was sent to the responsible surgeon in 1994 when 251 patients were alive and available. Ninety-four of the 251 patients agreed to undergo an abdominal and thoracic CT scan, and each scan was interpreted independently by two vascular radiologists.

Results : The aorta was analysed in five defined segments, and an aneurysm was defined as > 50% enlargement from the expected normal value as defined in the Reporting Standards for Aneurysms. Using this strict definition, 64.9% of patients had an aneurysm, but the abnormality was considered a possible indication for surgical repair in 13.8%. Of the 39 patients who had an initial repair with a tube graft, 12 (30.8%) were found to have an iliac aneurysm and 6 (15.4%) were considered to be of possible surgical significance. The median graft size at the time of operation was 18 mm, which increased to a median size of 22 mm at follow-up. Fluid or thrombus around the graft was observed in 28%, and bowel was intimately associated with the graft in 7%.

Conclusions : The longterm results of conventional open surgical repair is durable. CT scan follow-up between 8 and 9 years postoperatively often demonstrates aortic and iliac abnormalities, but the majority are not clinically significant. On the basis of these findings, a routine CT scan of the abdomen and chest is recommended after 5 years. This study provides a population based study for comparison with the longterm results of endovascular repair.

Key Words:

• Aneurysm
• abdominal aortic
• diagnosis
• surgery
• vascular grafts

Additional information

Notes on contributors

P.G. Kalman

Dr. P. g. Kalman M.D., FRCSC, FACS Professor of Surgery Chief, Division of Vascular Surgery Loyola University Medical Center 2160 South First Avenue Maywood, IL 60513 Tel.: [phone] Fax: [phone] E-mail: [email protected]