J Korean Surg Soc.  2011 Mar;80(3):212-220. 10.4174/jkss.2011.80.3.212.

Indications and Short-term Results of Open Surgical Repair of Abdominal Aortic Aneurysm in an Endovascular Era

• Roh YN
• Park YJ
• Kim DI
• Park KB
• Do YS
• Choi SH
• Kim DK
• Kim YW

• KMID: 1963585
• DOI: http://doi.org/10.4174/jkss.2011.80.3.212

Abstract

PURPOSE
To assess the role of OR in treatment of AAA patients, we reviewed the indications and our current results of OR of AAA.
METHODS
We retrospectively investigated the database of 366 patients (mean age, 68.3+/-8.7 years, male 86%) who underwent open surgical (n=291, 80%) or endovascular treatments (n=75, 20%) of AAA in a tertiary referral center between Sep. 2003 to Aug. 2010. Treatment-related morbidities and mortality rates within 30 days were investigated according to the indications for treatment, clinical features, anatomic location, and underlying causes of AAA.
RESULTS
According to the location of AAA, we treated 343 (94%) infrarenal, 17 (5%) juxtarenal and 6 (2%) suprarenal AAAs. Underlying causes of AAA were degenerative (90%), infected (3%), inflammatory (3%), Marfan's syndrome (2%), and vasculitis (0.5%). Clinically, 338 (92%) were non-ruptured and 28 (8%) were ruptured AAAs. 75% of patients were treated with OR after the inception of reimbursement of aortic device while 25% of patients were treated with EVARs. The operative mortality rates of OR was 0.4% in patients with non-ruptured infrarenal AAA, 0% in patients with non-ruptured juxta- and suprarenal AAA and 21.4% in ruptured AAA patients.
CONCLUSION
In an era of endovascular treatment of AAA, we have experienced excellent surgical results after OR in patients with non-ruptured AAA with various clinical features. Though EVAR is rapidly replacing OR in treatment of infrarenal AAAs, OR has its own role in treatment of AAA patients with unfavorable conditions for EVAR. The role of OR should not be underestimated.

Keyword

Abdominal aortic aneurysm; Surgical repair; Outcomes

MeSH Terms

Aortic Aneurysm, Abdominal*
Humans
Male
Marfan Syndrome
Mortality
Retrospective Studies
Tertiary Care Centers
Vasculitis

Figure

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  Fig. 1 Treatment algorithm for patients with abdominal aortic aneurysm (AAA).

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  Fig. 2 Result of preoperative cardiac evaluation before elective treatment of abdominal aortic aneurysm (AAA) (N=341). *Percutaneous coronary intervention; †Coronary artery bypass grafting.

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  Fig. 3 Indications for AAA treatment (Sep. 2003~Aug. 2010). *Thoracoabdominal aortic aneurysm.

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  Fig. 4 A patient who required open conversion during EVAR. (A) Completion angiogram during EVAR shows extravasation of contrast agent after deployment of the aortic stent graft with suprarenal fixing device. (B) An operative finding of ruptured abdominal aortic aneurysm (AAA) showing aortic stent graft. (C) Excised aortic stent graft device (Zenith®): suprarenal stents were removed during the operation. (D) Follow-up CT angiogram shows abdominal aortic and the left renal artery reconstructions.

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