Open Repair of AAA in a High Volume Center

• Published in: World journal of surgery 2017-03, Vol.41 (3), p.884-891
• Main Authors: Davidovic, Lazar B., Maksic, Milanko, Koncar, Igor, Ilic, Nikola, Dragas, Marko, Fatic, Nikola, Markovic, Miroslav, Banzic, Igor, Mutavdzic, Perica
• Format: Article
• Language: English
• Subjects: Abdominal Aortic Aneurysm; Abdominal Surgery; Adult; Aged; Aged, 80 and over; Aorta - surgery; Aortic Aneurysm, Abdominal - surgery; Bifurcate Graft; Cardiac Surgery; Comorbidity; Elective Surgical Procedures - adverse effects; Elective Surgical Procedures - mortality; Female; General Surgery; Hospitals, High-Volume; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Open Repair; Original Scientific Report; Postoperative Complications - etiology; Postoperative Complications - mortality; Retrospective Studies; Splenic Injury; Surgery; Thoracic Surgery; Vascular Surgery; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-016-3788-3

Objective To assess results of open repair (OR) of AAA in a single high volume center. Methods We analyzed prospectively collected data of 450 patients who underwent elective OR of AAA at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Centre in the period between January 2013 and September 2014. Results Postoperative death occurred in seven patients (1. 55%) during the first 30 postoperative days. The mortality was caused by: uncontrolled bleeding-1, acute myocardial infarction-1, ischemic colitis-2, MOFS-2, sepsis due to infection and dehiscence of laparotomy wound-1. Coronary artery disease (OR 3.89; CI 0.85–17.7; p  = 0.0058), postoperative acute myocardial infarction (OR 29.9; CI 2.56–334.95; p  = 0.0053), chronic renal failure (OR 7.5; CI 1.35–8.5; p  = 0.0073), colonic necrosis (OR 88.2; CI 4.77–1629.69; p  = 0.0026), occlusion of the both hypogastric arteries and the inability to preserve at least one hypogastric artery (OR 17.4; CI 1.99–178.33; p  = 0.0230), aortobifemoral reconstruction (OR 9.06; CI 1.76–46.49; p  = 0.016), significant perioperative bleeding (>2 L) (OR 7.32; CI 1.31–10.79; p  = 0.0001), hostile abdomen (OR 5.25; CI 1.3–21.1; p  = 0.0055), inflammatory aneurysm (OR 13.99; CI 2.88–65.09; p  = 0.0002), supraceliac aortic cross-clamping (OR 18.7; CI 3.8–90.6; p  = 0.0003), prolonged aortic cross-clamping (>60 min) (OR 14.25; CI 2.75–64.5; p  = 0.0003), the intraoperative hypotension (OR 6.61; CI 0.71–61.07; p  = 0.0545), the prolonged operation (>240 min) (OR 8.66; CI 0.91–81.56; p  = 0.0585) and complete dehiscence of the laparotomy (OR 44.1; CI 3.39–572.78; p  = 0.0396) increased the 30-day mortality in our study. Conclusions Early mortality after open repair of AAA in high volume center might be very low due to experienced multidisciplinary team. Centralized open aortic surgery might be solution for effective treatment of patients with unsuitable anatomy or for young patients with long life expectancy.