Multicenter prospective study of nonruptured abdominal aortic aneurysms. I. Population and operative management

• Published in: Journal of vascular surgery Vol. 7; no. 1; pp. 69 - 81
• Main Authors: Wayne Johnston, K., Keith Scobie, T.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01-01-1988; Elsevier
• Subjects: Aged; Aorta, Abdominal; Aortic Aneurysm - epidemiology; Aortic Aneurysm - etiology; Aortic Aneurysm - surgery; Biological and medical sciences; Blood and lymphatic vessels; Canada; Cardiology. Vascular system; Clinical Trials as Topic; Diseases of the aorta; Female; Humans; Male; Medical sciences; Prospective Studies; Regression Analysis; Risk Factors; Canada; Abdominal aorta; Human; Surgery; Aneurysm; Cardiovascular disease; Epidemiology; Aortic disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/0741-5214(88)90380-1

This article describes the patient population and operative management of 666 patients with nonruptured aneurysms of the abdominal aorta. Statistical significance of variables was determined by the chi-square test and logistic regression analysis. There were no statistically significant differences (p > 0.05) in mortality rate for abdominal aortic aneurysm (AAA) on the basis of indication for surgery (asymptomatic, 3.9%; asymptomatic but with evidence of enlargement, 4.9%; and symptomatic, 7.2%) or the urgency of operation (elective operation, 4.5%; and urgent operation, 7.1%). Characteristics of the 72 participating surgeons did not influence the operative mortality rate. A family history of AAA was documented in 6.1% of cases and was more common if the patient was female (p = 0.03) and less than 65 years of age (p = 0.04). Patients without clinical evidence of coronary artery disease had a 0.8% mortality rate from cardiac disease compared with 6.2% if any stigmata of coronary disease were present. Prior aortocoronary bypass surgery did not reduce the incidence of postoperative cardiac events or operative mortality rate. Patients having “routine” angiography did not have a less complicated operative course, fewer thrombotic complications, or lower mortality rate than those not having it. Those patients with an inflammatory AAA (4.5%) did not have a significantly higher incidence of pain. Heparin administration (84.8%) did not reduce the complications of graft thrombosis, “trash”, distal thrombosis, and/or amputation. The 6.8% of patients requiring suprarenal aortic cross-clamping had a higher incidence of postoperative renal dysfunction (p = 0.02) and intraoperative blood loss (p < 0.001), but cardiac events were not more frequent. When the aortic cross-clamping time was prolonged (more than 70 minutes), the requirement for crystalloid fluid administration increased (p < 0.001) and postoperative myocardial infarction was more common (p = 0.004). After ligation of the left renal vein in 7.9%, renal damage or dialysis was more frequent (p = 0.01). Patients having an intra-abdominal graft (tube, 38.5% and biiliac, 30.7%) had fewer wound infections (p = 0.02) and graft thromboses (p < 0.001) than the patients with a femoral anastomosis. When the internal iliac artery flow was interrupted bilaterally (12%), diarrhea (p = 0.03) and ischemic colitis (p = 0.03) were more frequent complications. Reimplantation of the inferior mesenteric artery was carried out in 4.8%. After renal artery bypass in 2.1%, the mortality rate was not increased, but the incidence of transient renal dysfunction was increased (p = 0.03). In the 6.6% having concomitant nonvascular surgery with potential for bacterial contamination, there were no cases of wound infection, but graft sepsis was the cause of death in one case. Observations from this prospective multicenter study can be generalized to reflect current surgical practice and standards of AAA surgery on a national level.