Long-term results after elective open surgical repair of abdominal aortic aneurysm : a 14-year follow-up study

Objectives This study evaluated long-term outcomes after elective open surgical repair (OSR) for abdominal aortic aneurysms (AAAs). Methods Data of all consecutive patients treated with OSR between 2000 and 2014 were retrospectively collected. Overall survival, reintervention rate, graft complications-free survival, and freedom from graft complications were analyzed. Results A total of 490 patients (93.3% men), mean age of 71.3 years, were reviewed. Median follow-up was 53 months (range, 1-14 years) and median surveillance time was 13.2 years. Overall survival at 30 days, and 1, 5, and 13 years was 97.3% ± 0.01%, 95.9% ± 0.01%, 84.6% ± 0.02%, and 52.2% ± 0.06%, respectively. Long-term mortality was influenced by age (HR, 1.08; confidence interval [CI], 1.05-1.11; P < .001), chronic obstructive pulmonary disease (HR, 1.50; CI, 0.96-2.23; P = .06), and chronic renal failure (HR, 1.87; CI, 1.11-3.16; P = .02). Thirty-five (9.6%) late graft-related complications were observed. There were no aortoenteric fistulas, but a ruptured femoral pseudoaneurysm (0.2%) resulted in one death. The 30-day, and 1-, 5-, and 13-year rates of freedom from graft complications were 100%, 100%, 96%, 69% and graft complications-free survival was 97%, 96%, 81%, and 39%, respectively. Preoperative aneurysm diameter and surgical graft caliber were related to late proximal pseudoaneurysms (HR, 1.98; CI, 1.37-2.93; P < .001; and RR, 2.08; CI, 1.53-2.79; P < .001 respectively), intraoperative graft thrombosis and postoperative pseudoaneurysm to graft limb occlusion (HR, 3.09; CI, 1.11-7.64; P = .03; HR, 3.09, CI, 1.11-7.64; P = .03, respectively). Conclusions OSR of AAA showed satisfactory 14-year follow-up rates in overall survival and in freedom from graft-related complications and could be considered the procedure of choice. Preoperative aneurysm diameter and graft caliber are most important risk factors for development of pseudoaneurysms and intraoperative graft thrombosis for late limb occlusion.