Results of surgical therapy and classification of non-ruptured abdominal aortic aneurysms

INTRODUCTION: Surgery for symptomatic aortic abdominal aneurysms (sAAA) is associated with an increased mortality and morbidity compared to asymptomatic aortic aneurysms (aAAA). With the advent of endovascular therapy, an alternative therapeutic modality has become available. Endovascular therapy, however, depends on certain morphologic criteria, whereas open surgery can be performed on any type of AAA. The purpose of this study was to analyse our data of surgical treatment of non ruptured AAA and to identify the amount of patients in whom endovascular therapy would have been possible. METHODS: Retrospective analysis of the medical data of all patients operated upon non ruptured AAA in our department by 3 responsible vascular surgeons from 1995-1999. RESULTS: 225 consecutive patients with a median age of 65 (42-95) years were included in the study. There were 184 (82%) male and 41 (18%) female patients with 143 (63.5%) aAAA and 82 (36.5%) sAAA. Patients with sAAA underwent emergency aneurysm repair and had a significantly increased aneurysm diameter compared to the aAAA, who underwent elective surgical aneurysm repair (6.9 +/- 1.6 cm vs. 6 +/- 1.2 cm; p = 0.002). A total of 11 (4.9%) patients had an inflammatory AAA. Smoking was found to be the only significant increased preoperative risk factor in the group of sAAA compared to aAAA (91 vs. 35 patients; p = 0.008). Morbidity was significantly increased in the patients with sAAA compared to the aAAA (55% vs. 31.5%; p = 0.041) The mortality however did not differ significantly in the two groups (2 vs. 3 patients; p = 0.691). Considering morphological criteria of the AAA, endovascular therapy would have been possible in 59 (26%) patients. However, in 24 (11%) of the 59 patients, endovascular therapy was not feasible because of aortic kinking, heavy calcification of the aneurysm neck, a patent inferior mesenteric artery or atherosclerotic diseased iliac arteries. Consequently, only 35 (15%) patients would have qualified for an endovascular therapy. DISCUSSION: Surgical therapy can be performed in patients with asymptomatic and symptomatic AAA with an equal low mortality. This finding underlines the fact, that surgical therapy still remains the standard therapy for AAA. In addition, in our study only a relative small amount of patients would have qualified for an endovascular therapy.