Key result
Surgical repair of ruptured abdominal aortic aneurysms was associated with a 5-year all-cause mortality of 55.1%, compared to 32.0% for elective repair.
Cohort (n=276)
No
Absolute Event Rate: 55.1% vs 32%
Mortality after elective AAA repair is relatively low at 30 days but reaches 32% at 5 years, whereas ruptured AAA carries a high short-term and long-term mortality risk.
High long-term mortality after ruptured AAA repair warrants cautious counseling; leaves open optimal post-repair strategies in observational data.
BACKGROUND AND AIMS: Abdominal aortic aneurysm is a degenerative vascular pathology with high mortality due to its rupture, which is why timely treatment is crucial. The current single-center retrospective study was undertaken to analyze short- and long-term all-cause mortality after operative treatment of abdominal aortic aneurysm and to examine the factors that influence outcome. MATERIAL AND METHODS: The data of all abdominal aortic aneurysm patients treated with open repair or endovascular aneurysm repair in 2004-2015 were retrospectively retrieved from the clinical database of Tartu University Hospital. The primary endpoint was 30-day, 90-day, and 5-year all-cause mortality. The secondary endpoint was determination of the risk factors for mortality. RESULTS AND CONCLUSION: Elective abdominal aortic aneurysm repair was performed on 228 patients (mean age 71.8 years), of whom 178 (78%) were treated with open repair and 50 (22%) with endovascular aneurysm repair. A total of 48 patients with ruptured abdominal aortic aneurysm were treated with open repair (mean age 73.8 years) at the Department of Vascular Surgery, Tartu University Hospital, Estonia. Mean follow-up period was 4.2 ± 3.3 years. In patients with elective abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 0.9%, 2.6%, and 32%, respectively. In multivariate analysis, the main predictors for 5-year mortality were preoperative creatinine value and age (p < 0.05). In patients with ruptured abdominal aortic aneurysm, 30-day, 90-day, and 5-year all-cause mortality rates were 22.9%, 33.3%, and 55.1%, respectively. In multivariate analysis, the risk factors for 30-day mortality in ruptured abdominal aortic aneurysm were perioperative hemoglobin and lactate levels (p < 0.05). According to this study, the all-cause mortality rates of elective abdominal aortic aneurysm and ruptured abdominal aortic aneurysm at our hospital were comparable to those at other centers worldwide. Even though some variables were identified as potential predictors of survival, the mortality rates after ruptured abdominal aortic aneurysm remain high. Early diagnosis, timely treatment, and detection of the risk factors for abdominal aortic aneurysm progression would improve survival in patients with abdominal aortic aneurysm.
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Lieberg et al. (2017) conducted a cohort in Abdominal aortic aneurysm (n=276). Ruptured abdominal aortic aneurysm vs. Elective abdominal aortic aneurysm was evaluated on 30-day, 90-day, and 5-year all-cause mortality. Surgical repair of ruptured abdominal aortic aneurysms was associated with a 5-year all-cause mortality of 55.1%, compared to 32.0% for elective repair.
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