Experiences in the Surgical Management of Abdominal Aortic Aneurysms

Abstract

From 1954 until 1967, a total of 52 patients with abdominal aortic aneurysms were referred to the University Surgical Unit and in 44 instances the aneurysm was resected. Nine patients (including one who had the aneurysm resected at a later date) were either rejected for surgery on general grounds or were explored but did not have the aneurysm resected. These cases are discussed. Out of the 44 cases undergoing aneurysmectomy, 11 died during the operation or in the first week after the operation, giving an overall mortality rate of 25 per cent. There were 13 asymptomatic aneurysms with no deaths, 16 aneurysms with symptoms indicating rapid expansion of the aneurysm with 2 deaths (mortality rate of 12.5%) and 15 aneurysms which had ruptured with 9 deaths (mortality rate of 60%). The main operative complications were haemorrhage, cardiac arrest and peripheral arterial thrombosis. Post-operative complications were respiratory insufficiency, renal insufficiency or failure, bowel ischaemia, wound infection and wound dehiscence. Of the 44 patients operated upon, 33 survived operation and left the hospital alive. Three patients have been lost to follow-up and there were 9 known late deaths due to suture-line rupture (2), coronary artery thrombosis (1), renal failure (1), pneumonia (2), embolism (1), bronchial carcinoma (1). Twenty-one patients are still alive having survived the operation for periods ranging from 6 months to 9 years. Atherosclerotic aortic aneurysms occur in elderly patients with other evidence of advanced systemic atherosclerosis. Nevertheless, these aneurysms are specifically dangerous and in the absence of surgical treatment the majority of the patients may be expected to die from rupture of the aneurysm. At the present time, in good circumstances, resection of an unruptured aortic abdominal aneurysm has an overall mortality rate of less than 10 per cent but, should surgery be deferred until the aneurysm has ruptured, the operative mortality rate is 50 per cent or more. Patients surviving operation can expect a very satisfactory restoration of physical well-being.