Complications of Abdominal Aortic Reconstruction An Analysis of Perioperative Risk Factors in 557 Patients

TLDR

The study retrospectively analyzed 557 patients (mean age 63) who received Dacron graft replacement of the abdominal aorta at the Cleveland Clinic between 1974 and 1978. Postoperative complications occurred in 20 % of patients, with mortality rates of 5.1 % for intact aneurysms, 26 % for ruptured aneurysms, and 2.3 % for aortoiliac occlusive disease; myocardial infarction was the leading cause of death (3.1 %), while temporary renal failure (7.0 %) and pulmonary insufficiency (5.9 %) were also common, and age over 60, suspected coronary artery disease, serum creatinine >2.0 mg/dl, renal artery revascularization, aneurysm rupture, and intraoperative blood loss were significant predictors of mortality.

Abstract

From 1974 through 1978, 557 patients (mean age: 63 years) underwent Dacron graft replacement of the abdominal aorta at the Cleveland Clinic. Postoperative complications occurred in 110 patients (20%), with mortality rates of 5.1% for those having intact aortic aneurysms, 26% for those with ruptured aneurysms, and 2.3% for those with aortoiliac occlusive disease. Myocardial infarction was the most common cause of postoperative death, affecting 3.1% of the entire series, but all 87 patients who had previously required myocardial revascularization survived subsequent aortic procedures (p less than 0.01). As defined in this investigation, temporary renal failure (7.0%) or pulmonary insufficiency (5.9%) were encountered more frequently than were other complications, but each of these was the singular cause of death in only 0.2% of all patients. Several risk factors significantly influenced postoperative mortality, (p less than 0.01), including age over 60 years, suspected coronary artery disease, serum creatinine greater than 2.0 mg/dl, complementary renal artery revascularization, and aneurysm rupture. In addition, intraoperative blood loss had a statistically valid correlation with postoperative mortality (p less than 0.01), myocardial infarction (p less than 0.010, renal failure (p less than 0.001), and pulmonary insufficiency (p less than 0.001).