Perioperative outcome following open surgical repair of symptomatic non-ruptured abdominal aortic aneurysm

Introduction. Symptomatic non-ruptured abdominal aortic aneurysm represents an intermediate clinical entity between elective aneurysms and ruptured disease. This study aimed to compare perioperative outcomes and the incidence of acute kidney injury incidence between patients undergoing open surgical repair for symptomatic versus asymptomatic abdominal aortic aneurysms. Material and Methods. This retrospective cohort study included 178 patients who underwent open surgical repair for infrarenal abdominal aortic aneurysm between January 2021 and January 2023. Patients were classified as symptomatic (n = 60) if they presented with abdominal or back pain, limb ischemia without rupture, and as asymptomatic (n = 118) if treated electively. Demographic characteristic, comorbidities, intraoperative parameters, and postoperative outcomes were analyzed. Results. Symptomatic patients had a significantly larger mean aneurysm diameter compared with asymptomatic patients (74.5 vs. 64.2 mm; p < 0.001). Overall postoperative complications occurred more frequently in symptomatic patients (28.3% vs. 9.3%; p = 0.001), particularly cardiac complications (10% vs. 2.5%; p = 0.032). The length of hospital stay was significantly longer in the symptomatic group (10.1 vs. 8.4 days; p = 0.004). The incidence of postoperative acute kidney injury did not differ significantly between groups (31.7% vs. 27.1%; p = 0.53). However, preoperative chronic kidney disease and anemia were strong predictors of postoperative acute kidney injury. Thirty-day mortality was higher in symptomatic patients (8.3% vs. 3.4%) although the difference did not reach statistical significance (p = 0.40). Conclusion. Symptomatic nonruptured abdominal aortic aneurysm is associated with larger aneurysm size, higher complication rates, and prolonged hospitalization. Nevertheless, open surgical repair can be performed with acceptable outcomes in specialized centers.