Updates in Surgery

, Volume 70, Issue 1, pp 129–136 | Cite as

Mortality rates and risk factors for emergent open repair of abdominal aortic aneurysms in the endovascular era

  • Felice Pecoraro
  • Steffen Gloekler
  • Caecilia E. Mader
  • Malgorzata Roos
  • Lyubov Chaykovska
  • Frank J. Veith
  • Neal S. Cayne
  • Nicola Mangialardi
  • Thomas Neff
  • Mario Lachat
Original Article
  • 156 Downloads

Abstract

The background of this paper is to report the mortality at 30 and 90 days and at mean follow-up after open abdominal aortic aneurysms (AAA) emergent repair and to identify predictive risk factors for 30- and 90-day mortality. Between 1997 and 2002, 104 patients underwent emergent AAA open surgery. Symptomatic and ruptured AAAs were observed, respectively, in 21 and 79% of cases. Mean patient age was 70 (SD 9.2) years. Mean aneurysm maximal diameter was 7.4 (SD 1.6) cm. Primary endpoints were 30- and 90-day mortality. Significant mortality-related risk factor identification was the secondary endpoint. Open repair trend and its related perioperative mortality with a per-year analysis and a correlation subanalysis to identify predictive mortality factor were performed. Mean follow-up time was 23 (SD 23) months. Overall, 30-day mortality was 30%. Significant mortality-related risk factors were the use of computed tomography (CT) as a preoperative diagnostic tool, AAA rupture, preoperative shock, intraoperative cardiopulmonary resuscitation (CPR), use of aortic balloon occlusion, intraoperative massive blood transfusion (MBT), and development of abdominal compartment syndrome (ACS). Previous abdominal surgery was identified as a protective risk factor. The mortality rate at 90 days was 44%. Significant mortality-related risk factors were AAA rupture, aortocaval fistula, peripheral artery disease (PAD), preoperative shock, CPR, MBT, and ACS. The mortality rate at follow-up was 45%. Correlation analysis showed that MBT, shock, and ACS are the most relevant predictive mortality factor at 30 and 90 days. During the transition period from open to endovascular repair, open repair mortality outcomes remained comparable with other contemporary data despite a selection bias for higher risk patients. MBT, shock, and ACS are the most pronounced predictive mortality risk factors.

Keywords

Abdominal aortic aneurysm Open repair Endovascular aneurysm repair Mortality Ruptured Symptomatic 

Notes

Compliance with ethical standards

Funding

No funding were received for the study.

Conflict of interest

All authors declared that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  • Felice Pecoraro
    • 1
    • 2
  • Steffen Gloekler
    • 3
  • Caecilia E. Mader
    • 4
  • Malgorzata Roos
    • 5
  • Lyubov Chaykovska
    • 1
  • Frank J. Veith
    • 6
  • Neal S. Cayne
    • 6
  • Nicola Mangialardi
    • 7
  • Thomas Neff
    • 8
  • Mario Lachat
    • 1
  1. 1.Clinic for Cardiovascular SurgeryUniversity Hospital ZurichZurichSwitzerland
  2. 2.Vascluar Surgery UnitUniversity Hospital “P. Giaccone”PalermoItaly
  3. 3.Department of CardiologyUniversity Hospital BernBernSwitzerland
  4. 4.Department of RadiologyUniversity Hospital ZurichZurichSwitzerland
  5. 5.Institute for Social- and Preventive MedicineUniversity of ZurichZurichSwitzerland
  6. 6.Division of Vascular SurgeryNew York University Medical CenterNew YorkUSA
  7. 7.Department of Vascular SurgerySan Filippo Neri HospitalRomeItaly
  8. 8.Department of Anesthesiology and Intensive Care MedicineCantonal Hospital of MuensterlingenMuensterlingenSwitzerland

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