Long-Term Survival After Repair of Proximal Abdominal Aortic Aneurysms

To review our 26-year clinical experience with open proximal abdominal aortic aneurysm (AAA) repair, with a focus on long-term survival. A retrospective cohort study was performed of all patients who underwent proximal AAA repair between 1985 and 2011 at a tertiary care referral center. Demographics, operative variables, and early and late complications, as well as 30-day mortality, were analyzed. Mid- and long-term survival was assessed through review of the electronic medical records and the Social Security Death Index. The Kaplan-Meier method was used to calculate patient survival. Univariate Cox regression and hazard ratio (HR) estimates were used to test for associations between demographic variables, complication variables, and survival to determine predictors of adverse outcomes. Two hundred forty patients were identified. Mean age was 76 years (range, 38-92 years). Seventy percent were male, and 90% were Caucasian. Aneurysm type was juxtarenal in 124 (55%) patients, suprarenal in 66 (25%) patients, and type IV thoracoabdominal in 50 (20%) patients. Thirty-day mortality was 3% (eight patients), and in-hospital mortality was 4% (nine patients). At least one major complication occurred in 49% of the patients, which included: acute renal dysfunction (increase Cr >0.5 mg/dL from baseline), 40%; hemodialysis at discharge, 1.6%; myocardial infarction, 3%; pulmonary complication, 23%; paraplegia, 0.5%; and visceral ischemia, 1.7%. Median follow-up was 54 months. Late complications included one graft infection and one limb occlusion. Kaplan-Meier survival estimates were 70% at 5 years, and 43% at 10 years. Variables associated with poorer survival included: congestive heart failure (HR, 3.6; P < .001), chronic obstructive pulmonary disease (HR, 1.6; P < .012), history of aortic dissection (HR, 7.997; P < .046), current tobacco use (HR, 1.5; P = .048), and increasing aneurysm size (HR, 1.1; P < .005). Open surgical repair of proximal AAA can be performed with low mortality. Temporary renal insufficiency is the most frequent complication, but the need for permanent hemodialysis is low. Late complications are rare, and long-term survival is favorable. This data should assist in establishing a benchmark for endovascular repair of these complex aneurysms.