• 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)" courtesy of SouthBank University, London; used with permission	"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.