Open infrarenal abdominal aortic aneurysm repair: The Cleveland Clinic experience from 1989 to 1998

• Published in: Journal of vascular surgery Vol. 35; no. 6; pp. 1145 - 1154
• Main Authors: Hertzer, Norman R., Mascha, Edward J., Karafa, Mathew T., O'Hara, Patrick J., Krajewski, Leonard P., Beven, Edwin G.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.2002; Elsevier
• Subjects: Aged; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - surgery; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation; Cardiology. Vascular system; Diseases of the aorta; Female; Humans; Length of Stay - statistics & numerical data; Male; Medical sciences; Multivariate Analysis; Postoperative Complications - epidemiology; Risk Factors; Survival Rate; Treatment Outcome; Human; Endoprosthesis; Prognosis; Aneurysm; Instrumentation therapy; Cardiovascular disease; Survival; Arterial disease; Vascular disease; Abdominal aorta; Treatment; Follow up study; Aortic disease; Bibliographic review
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2002.123686

Purpose: The purpose of this study was to determine the safety and durability of traditional surgical treatment for asymptomatic infrarenal abdominal aortic aneurysms (AAAs) in a large series of patients who underwent open operations during the decade preceding the commercial availability of stent graft devices for endovascular AAA repair. Methods: From 1989 to 1998, 1135 consecutive patients (985 men [87%], 150 women; mean age, 70 ± 7 years) underwent elective graft replacement of infrarenal AAA. Computerized perioperative data have been supplemented with a retrospective review of hospital charts/outpatient records and a telephone canvass to calculate survival rates and the incidence rate of subsequent graft-related complications. Seventy-four patients (6.5%) were lost during a median follow-up period of 57 months for the entire series. Results: The 30-day mortality rate was 1.2%. The hospital course was completely uneventful for 939 patients (83%), and the median length of stay for all patients was 8 days. A total of 196 patients had single (n = 150; 13%) or multiple (n = 46; 4%) postoperative complications, which were more likely to occur in men (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.1 to 5.2) and in patients with a history of congestive heart failure (OR, 3.7; 95% CI, 1.7 to 7.8), chronic pulmonary disease (OR, 1.9; 95% CI, 1.2 to 2.9), or renal insufficiency (OR, 2.5; 95% CI, 1.3 to 4.7). Kaplan-Meier method survival rate estimates were 75% at 5 years and 49% at 10 years. As was the case with early complications, the long-term mortality rate primarily was influenced by age of more than 75 years (risk ratio [RR], 2.2; 95% CI, 1.7 to 2.8) or previous history of congestive heart failure (RR, 2.1; 95% CI, 1.3 to 3.4), chronic pulmonary disease (RR, 1.5; 95% CI, 1.2 to 2.0), or renal insufficiency (RR, 3.2; 95% CI, 2.2 to 4.6). Of the 1047 patients who survived their operations and remained available for follow-up study, only four (0.4%) have had late complications that were related to their aortic replacement grafts. Conclusion: These results reconfirm the exemplary success of open infrarenal AAA repair. The future of endovascular AAA repair is exceedingly bright, but until the long-term outcome of the current generation of stent grafts is adequately documented, their use should be justified by the presence of serious surgical risk factors. (J Vasc Surg 2002;35:1145-54.)