Open Repair of Infra Renal Abdominal Aortic Aneurysms: A Single Center Experience from the Developing World

Abstract

Introduction: In the absence of endovascular aneurysm repair due to financial constraints, Abdominal Aortic Aneurysm (AAA) in Sri Lanka is managed exclusively by open surgery. We report our experience with open AAA repair with emphasis on peri-operative morbidity and mortality. Methods: Seventy nine consecutive open AAA repairs were carried out between April 2004 and March 2010. A multiple regression model was used to identify predictors of significant peri-operative morbidity and mortality. Results: Mean age of the study cohort was 68 years. There were 63 (80%) males and 16 (20%) females. Mean aneurysm diameter was 6.4 (3.5-9.70) cm. Twenty seven (34%) underwent emergency surgical repair (group-1) while 52 (66%) had elective repair (group-2). The peri-operative mortality was 10/27 (37%) in group-1, 4/52 (7.6%) in group-2, (p = 0.0035). Significant post-operative morbidity was seen in 5/17 (29%) in group-1 and 7/48 (15%) in group-2, (p = 0.27). Aneurysm diameter >7 cm (p = 0.001), emergency repair (p = 0.004), history of smoking (p = 0.002), aortic cross-clamp time >60 minutes (p = 0.044), and need for post-operative ventilwation >24 hours (p = 0.024) were found to be independent predictors of peri-operative mortality or significant morbidity. Conclusion: Open aneurysm repair still has a strong place especially in the limited resource setting, with acceptable outcomes.