The Influence of the Diameter of the Infrarenal Abdominal Aortic Aneurysm on the Outcome of Treatment

INTRODUCTION: Abdominal aortic aneurysm (AAA) is usually asymptomatic, and its first manifestation in most cases is a dissection or rupture, with a mortality rate exceeding 90%. Until now, the aspect of the possible effect of the diameter of the AAA on mortality after surgical treatment has not been practically studied. AIM: To study the influence of the size of AAA as a risk factor for fatality in its surgical treatment. MATERIALS AND METHODS: This study is retrospective. The study included 226 patients who underwent open and endovascular procedures for an infrarenal abdominal aortic aneurysm (iAAA) in the period 2011–2015 on the basis of the Department of Cardiovascular Surgery of the Ryazan State Medical University (Ryazan, Russia) and in 2011–2017 at the Republican Scientific Center of Cardiovascular Surgery (RSCSC) (Dushanbe, Tajikistan). There were 60 patients from Dushanbe and 166 from Ryazan. The work is part of a study on the treatment of patients with AAA and registered on the platform ClinicalTrials.gov (NCT04935268). RESULTS: Of the total number of patients with iAAA (n = 226), the number of males and females was 174 (77%) and 52 (23%), respectively, and the average age was 69.4 ± 2.6 years. The diameters of aneurysms in the RT and in the RF did not differ statistically significantly, the comorbidity rate per patient reached 1.84. In the RF and RT the number of operated patients for AAA was 31.3% and 26.7% (p > 0.05), respectively. The average diameter of the AAA in patients who survived surgery for the treatment of iAAA was 57.0 mm [53.5; 60.5] and 59.0 mm [48.0; 73.0] (p > 0.05, U = 2953.5; Z = 0.91), respectively. The diameter of the AAA in deceased patients after surgery (planned and rupture) in the RT and the RF is 60.0 mm [55.0; 65.5] and 72.0 mm [53.5; 80.5] (p > 0.05, U = 129.0; Z = 1.14), respectively. In the RT, the size of the AAA is not associated with a fatal outcome (57.0 mm [53.5; 60.5] and 60.0 mm [55.0; 65.5]; p > 0.05 (U = 207.0; Z = 1.49)). In the RF the size of the AAA in deceased patients was statistically significantly larger than in survivors — 72.0 mm [53.5; 80.5] and 59.0 mm [48.0; 73.0], respectively; p = 0.029 (U = 1394.5; Z = 2.18). The 30-day mortality rate after planned and emergency operations was comparable between the patients of the two clinics. CONCLUSION: The diameter of the AAA is a risk factor for the development of a fatal outcome after treatment.