S.R. Amundsen

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.

Abdominal aortic aneurysms—A study of factors influencing postoperative mortality

Factors which influenced outcome after surgery have been studied in 444 patients with abdominal aortic aneurysm included in a Norwegian multicentre study. Two-hundred and seventy-nine patients were treated electively, 51 had impending rupture and 114 had a ruptured aneurysm. In the elective group age, a large aneurysm, impaired renal function, the presence of angina pectoris and intraoperative blood loss of more than 4 units were found to significantly increase hospital mortality. In the impending rupture group excess blood loss during the operation had a negative influence on hospital death but the limited number of patients in this group restricts the value of analysis. A low systolic blood pressure and an older patient were the only 2 risk factors which had a detrimental effect on postoperative survival in the ruptured group. The formulation of a risk index for these patients was not possible although Odds ratios for the individual factors found to be of importance may give some risk estimates.

Abdominal aortic aneurysms—A national multicentre study

A prospective, observational, multicentre study has been carried out on 444 consecutive patients with abdominal aortic aneurysms to study the effect of the diffusion of vascular service on treatment results. Two-hundred and seventy-nine patients were admitted for elective surgery (E), 114 patients had a ruptured aneurysm (R), and 51 had impending rupture (IR). Patients with acute symptoms (R + IR) were generally older and had larger aneurysms than the E group. The postoperative mortality was 7.5%, 16.7%, and 63.1% in the E, IR and R group respectively. The study demonstrates that overall treatment results in these high risk patients are inferior to results published from specialised institutions. Consequently, the diffusion of vascular surgical service seems not to have worked to the benefit of our patients although further analysis may modify this conclusion.

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.

Non-curative surgery for aortoenteric fistula

Abstract Graft infection with secondary aortic fistula is a rare complication following implantation of aortic prostheses, frequently occurring after emergency procedures and reoperations. The condition is associated with considerable morbidity and mortality. Curative treatment consists of explantation of the infected graft followed by fistula revision and implantation of a new graft in combination with antimicrobial therapy. Non-curative treatment with aortic stentgraft and long-term substitution treatment with antibiotics may be an option in cases where graft explantation is deemed too risky. We present an elderly patient with aortoenteric fistula following surgery for ruptured abdominal aortic aneurysm. Implantation of an aortic stentgraft and fistula revision was performed but the original aortic prosthesis was not explanted. The aortoenteric fistula recurred twice, but the patient has survived more than 12 years following non-curative surgery with good quality of life.