• Overview: Morbidity/mortality

  •  Abdominal aortic aneurysm:

    •  Following rupture: very high mortality (> 50%)

    •  Surgical Intervention: morbidity/mortality

      • Mortality from elective abdominal aneurysm surgery: about 8% (twofold higher than that associated with occlusive major vascular disease)

    • Approximate median survival following surgery:

      • abdominal aneurysmal repair: about 6 years

      • aorticoiliac revascularization: about 11 years

  •  Basis for Morbidity/ mortality:

    •  Secondary to myocardial dysfunction (correlation may be as high as 100% -- death due to cardiac disease)

    •  Conservative treatment, i.e. observing aneurysmal growth until size becomes > 6 cm, has NOT been well  accepted despite relatively high surgical risk

    •  Since 1990, perioperative mortality has declined; however high mortality (45%-90%) continues to be associated with emergency surgery for ruptured aneurysm

      • Predicting which patients will suffer in aneurysmal rupture: unreliable

    • Patients undergoing aneurysmal surgery tend to be older (10 years) than patients undergoing aortic revascularization.  

      • Older patients tend to higher risk of adverse outcome; after correcting for age, life expectancy following aneurysmal surgery is less than that for revascularization.

Other Factors Affecting Outcome

Cardiovascular Disease

• "Normal left coronary angiogram. Left  anterior oblique view (45 degrees) (Left); Left coronary angiogram.  Left anterior oblique view.  Narrow area from disease proximal end of circumflex and top of anterior descending.  Male age 37. Severe angina not controlled by medical treatment": courtesy of SouthBank University, London; used with permission

• Most patients undergoing aortic reconstruction had clinical evidence of coronary vascular disease

• Strongest preoperative indicator of postoperative my guarded complications was the presence of both preexisting cardiac disease and diabetes

• Age: Significant increase in risk with increasing age

  • Greater effect on mortality than coronary vascular disease presents or aortic aneurysm rupture history

• Renal Disease/Failure

  •  Factors that increase mortality risk:

    • Postoperative renal failure (if serious enough to record analysis)

    • Preexisting renal disease

  •  Factors that decreased risk:

    • improved intravascular volume management by anesthesia providers

• Smoking and pulmonary disease

  • Unclear relationship between smoking and vascular surgery outcome

  •  Smoking increases respiratory complications following bypass surgery

  • Smoking cessation two months before surgery may reduce risk for complications by 66% (compared to patients who stop smoking < two months before the procedure)

• Diabetes mellitus

  •  Diabetic patients are usually classified as type III, associated with a  reduced five-year survival rates ( 65%,secondary to small vessel disease)

  • Also associated with increased likelihood of surgical wound complication. 

• Primary Reference: Katz, J.,  Evaluation Risk Assessment of Patients with Vascular Disease in Principles and Practice of Anesthesiology (Longnecker, D.E., Tinker, J.H. Morgan, Jr., G. E., eds)  Mosby, St. Louis, Mo., pp. 201-218, 1998.