Purpose: The aims of this study were to analyze clinical characteristics of the patients with AAA (Abdominal aortic aneurysm) and to report the results of AAA repair. We also compared the results of open repair (OR) with those of endovascular repair (ER) to evaluate the short-term efficacy of ER, especially in high-risk patients.
Methods: We reviewed the medical records of 118 (28 ruptured 90 unruptured) patients who underwent AAA repair in Seoul National University Hospital from September 1986 to September 2002. We also compared the treatment outcomes of ER (n=21) with those of conventional OR (n=37) for unruptured AAA during the period July 1995 to September 2002.
Results: The mean aneurysm size was larger in ruptured AAA patients (8.49 cm vs. 6.67 cm, P<0.01) The most frequent ccmorbidity was hypertension (51.7%, n=61). Abdominal discomfort or pain was the most frequent symptom. The hospital mortality in ruptured AAA was higher than in unruptured AAA (35.7% vs. 4.4%, P=0.01), especially in intraabdominal free rupture (80%). The complications of OR were rather systemic, but those of ER repair were all local or vascular complications such as endoleak and graft thromboembolism. The graft failure rate was significantly higher in ER than in OR (P=0.001), but ER resulted in shorter operation time and length of ICU stay, less blood loss and a lower necessity for general anesthesia than OR. No significant difference was found in hospital mortality or survival rate.
Conclusion: Ruptured AAA still has high operative mortality, especially in free ruptured AAA. We suggest that elective operation be performed before rupture occurs. Because the short-term outcomes of ER are considered to be acceptable, ER may be helpful especially in the patients with high operative risk. But further study of the long-term results of ER for AAA should be followed.
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