S. Aune

Operative Mortality and Long-term Relative Survival of Patients Operated on for Asymptomatic Abdominal Aortic Aneurysm

OBJECTIVE Assessment of mortality and long-term relative survival following repair of asymptomatic abdominal aortic aneurysms. DESIGN Retrospective review. SETTING University Hospital. MATERIALS Three hundred and twenty seven patients with a median age of 68 years and male to female proportion of 10:1. CHIEF OUTCOME MEASURES Operative mortality and long-term mortality obtained from Norwegian Registrars Office. Demographically matched expected survival calculated from death rate tables published by the Norwegian Central Bureau of Statistics. MAIN RESULTS The overall operative mortality was 5.2%. Ten-year survival rate for all the patients was 38% compared to the expected of 52%. The standard mortality rate was 1.30, indicating a 30% higher mortality compared to a demographically matched population. Older patients and patients with known cardiac disease had significantly increased operative mortality. These patients also had the lowest long-term survival. Patients with cardiac disease suffered a postoperative mortality more than two times expected. CONCLUSIONS Further studies are needed to define subgroups unsuitable for elective surgery.

Operative mortality and long-term survival of patients operated on for acute lower limb ischaemia

OBJECTIVES To investigate the operative mortality and long-term survival of patients with lower limb embolism or acute thrombosis. DESIGN A retrospective survival analysis. MATERIALS Eighty patients with acute thrombosis treated by bypass and 192 patients with embolism treated by embolectomy during the years from 1985 to 1996 were studied. METHODS The observed survival rates were calculated with the product limit method. The expected survival rates were estimated from death-rate tables. The standard mortality rate was compared over a 5-year follow-up. RESULTS The patients treated for embolism had an operative mortality of 17% and a 5-year survival rate of 17%, which was significantly lower than the expected rate of 62%. Those treated for acute thrombosis had an operative mortality of 14% and a 5-year survival rate of 44%. This was significantly higher than for the embolism group, but significantly lower than the expected rate of 74%. Both groups had a standard mortality rate of 2.2 at 5 years. CONCLUSION Patients with acute ischaemia have a poor short-term and long-term prognosis. The patients treated for embolism are older and they have a shorter life expectancy than those treated for acute thrombosis. The standard mortality rate of the two groups appears similar.

SURGICAL TREATMENT OF POPLITEAL ARTERY ANEURYSMS

Objectives: To report the results of surgical treatment of popliteal aneurysms with respect to symptoms and aneurysm size. Design: A retrospective study based on prospectively registered data, in a single vascular unit. Patients and Methods: Forty-nine patients were subjected to 57 operations from May 1974 to June 2000. Patency and limb salvage rates are compared for limbs with and without symptoms of ischaemia, and for small (2 cm or less) and large (> 2 cm) aneurysms. The long-term survival rate was calculated and compared with that of an age and sex-matched population. Results: The overall 5 year graft patency was 60 %. It was 83 % for asymptomatic limbs and 49 % for limbs with ischaemic symptoms. This difference was significant (p < 0,05). The overall 5 year limb salvage rate was 76 %. It was 100 % for asymptomatic and 64 for symptomatic limbs and this difference was significant (p < 0,05). Twenty-one of the aneurysms were 2 cm or less in diameter and 85 % of these caused symptoms of ischemia. The operative mortality was 4 %. The 5-year survival rate was 57 % and significantly lower than that of a demographically matched population. Conclusion: The results of prophylactic operations for popliteal aneurysms on asymptomatic limbs are significantly better than those of operations done on limbs with ischaemic symptoms. The aneurysm size at which to recommend surgery is still not settled.

The Influence of Age on Operative Mortality and Long-term Relative Survival Following Emergency Abdominal Aortic Aneurysm Operations

OBJECTIVE To study operative mortality and long-term survival following emergency operations for abdominal aortic aneurysm. DESIGN Retrospective survey in a university hospital. MATERIALS Two hundred and twenty-seven patients with median age 72 years, (17% women). METHODS Founded on data from the Norwegian Registrars Office, operative mortality and long-term survival was estimated using the life-table method. Expected survival for demographically matched subgroups was calculated from death rate tables issued by the Norwegian Central Bureau of Statistics. RESULTS Operative mortality was 41% for the 175 patients with ruptured aneurysms and 17% for the 52 with imminent rupture. The 6-year survival rate was 61% for all the successfully operated patients, and not different from that of a demographically matched population. For the patients of 72 years or older the 6-year survival rate was 53%. This was equal to that of an age and sex matched population. The younger patients had an observed 6-year survival rate of 64%, which was significantly lower than the expected of 84%. The standard mortality rate for this group was 2.25. No statistically significant difference in long-term survival was detected between the two age groups. CONCLUSIONS Age at the time of the operation for a symptomatic abdominal aortic aneurysm does not seem to influence long-term survival. Consequently, younger patients experience a higher relative mortality compared to the older.

Treatment of a Hepatic Artery Aneurysm by Endovascular Stent-Grafting

Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization. Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm.

The influence of age on long-term survival pattern of patients operated on for lower limb ischaemia

OBJECTIVE To study the long-term survival patterns of patients subjected to surgery for lower limb ischaemia. DESIGN A retrospective clinical study. SETTING University Hospital. MATERIALS A series of 1411 patients older than 50 years operated on for all stages of lower limb ischaemia. CHIEF OUTCOME MEASURES Observed and expected long-term survival rates were calculated. Relative survival, defined as the ratio of the observed to the expected survival rates, was studied for age influence. MAIN RESULTS The observed 10 year survival rate of 26% was significantly lower than the expected of 49%. Although women were 8 years older than men at the time of the operation they had similar long-term survival and relative survival. An inverse proportionality was found between the patients age at the time of the operation and relative survival. The young patients experienced a 10 year mortality rate three to four times the expected, while the older had a mortality that was elevated 25-50% from the expected. CONCLUSIONS Patients operated on for lower limb ischaemia experience a significantly lower long-term survival than that of a demographically matched population. This relative survival is significantly influenced by the patients age at the time of the operation.

Relative mortality of patients operated for femoropopliteal occlusive disease.

The postoperative survival of 410 patients operated for femoropopliteal occlusive disease was evaluated retrospectively. Claudicants and patients operated for critical ischaemia were separated by age and their relative mortality compared. The relative mortality risk based on standard mortality rate calculations was estimated by relating observed survival to age and sex adjusted expected survival rates. The statistical differences in observed mortality from the expected was assessed using the Mantel-Haenszel test, and a proportional-hazard test, based on a multiplicative model, was employed to compare differences in relative mortality risk. The five-year observed and expected survival for all patients was 59 and 78% respectively, indicating a doubled risk of mortality. No conspicuous differences were found between males and females. Patients operated on for intermittent claudication were significantly younger and lived significantly longer than those with critical ischaemia. There was, however, no difference in relative mortality risk for the two groups. Claudicants younger than 70 years lived longer than the older patients, but there was no difference in relative death risk for the two groups. Patients operated on for critical ischaemia showed similar mortality for younger and older patients but the younger patients had a three to four times higher relative risk of mortality compared to the older.

Association between the number of vascular operation on the lower limbs and long term survival.

OBJECTIVE To investigate to what extent the need for more than one vascular operation for chronic lower limb ischaemia was associated with relative long term survival. DESIGN Retrospective observational study. SETTING University hospital, Norway. SUBJECTS 1574 patients (29% women) operated on for chronic lower limb arterial insufficiency. Of these 447 needed at least one further operation for progressive limb ischaemia. MAIN OUTCOME MEASURES Long term survival estimated by the Kaplan-Meier method. The expected survival was calculated from mortality tables issued by the Norwegian Central Bureau of Statistics. RESULTS The 10-year survival rate was 46% for the patients operated on once and 24% for the patients who had two or more operations. The expected survival rates were 57% and 52%, respectively. Both categories of patients had significantly shorter long term survival than a demographically-matched population. The long term survival of patients operated on twice or more was significantly less than that of those who needed only one operation. CONCLUSION There is an association between the need for more than one vascular operation and long-term survival. Atherosclerotic disease among these patients seems to be more aggressive.

Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is technically feasible with acceptable long-term results

OBJECTIVES To investigate the results of endovascular treatment of symptomatic, atherosclerotic lesions of the infrarenal aorta. PATIENTS AND METHOD This is a retrospective study including 30 procedures performed on 25 patients in the period from 1990 through 2003. There were 16 women (64%) and 9 men, with a mean age of 55 years (range 35-81 years). The indication was disabling intermittent claudication in all cases. Preoperative assessment was done with ankle-arm pressure measurement and angiography. The mean length of the lesions was 2.5cm (range 1-6cm). One lesion was a short occlusion and nine were >90% stenoses. The remaining 20 lesions were significant (>70%) stenoses. The procedure was done with PTA alone in 13 cases, and with additional stenting in 17. RESULTS The procedures were technically successful in 28 cases and clinically successful in all 30. In two cases, a >50% residual stenosis was not dilated further because of stretch pain. The mean observation time was 40 months (range 0-135 months). The primary 2 and 5 year patency rates calculated on basis of intention to treat were 90 and 77%. The primary assisted patency rate was 90% at 2 years and 83% at 5 years. Eight patients developed significant restenosis, of which five were treated with a new endovascular procedure. Two failures were treated conservatively and one with surgical thrombendarterectomy. CONCLUSION Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is feasible in patients with suitable anatomy. Clinical success rates are high and long-term patency is good. Complications are few and minor. The majority of failures are amenable to new endovascular treatment.