Veinte años en la reparación abierta electsiva de los aneurismas de aorta abdominal infrarrenal

Aim. To present the morbidity and mortality rates in the open repair of abdominal aortic aneurysms (AAA) in our service and to study the different factors that can influence them. Patients and methods. We studied 309 patients who had undergone elective open repair of their AAA between 1987 and 2006. Three hundred and four were males (98.4%) and the mean age was 67.9 ± 7.1 years. Cases were divided into four five-year periods for the study. Results. One hundred and thirteen patients (36.6%) were classified, according to the American Society of Anaesthesiologists (ASA) classification, as ASA II, 168 (54.4%) were ASA III and 28 (9.1%) as ASA IV. Nine patients (2.9%) died during the postoperative period, the main cause being the pulmonary (55.5%). There were 56 cases of post-operative complications (18.1%), 44 general complications (14.2%) and 12 arising from the technique employed (3.9%). The number of patients who underwent surgery to increase the aortic diameter rose significantly with time (from 3.3 to 40%), and the same occurred with patients with ASA III (from 57 to 73.4%). There was a significant decrease in mortality in ASA IIIpatients (from 10 to 0%) and in the time spent in the intensive care unit (from 3.4 to 3.1 days). The aortic occlusion time, however, rose significantly (from 53.6 to 68.5 min). With a mean follow-up of 77.3% months, the survival rate was 77.3%, and the main cause of death was heart disease (12.7%). There were a total of 19 late complications deriving from the graft (6.3%), the most frequent being distal anastomotic aneurysms (2%). Conclusions. At the present time, elective open repair is an excellent technique for AAA treatment, with a very low rate of in-hospital mortality and few complications in its long-term follow-up.