Literature review of surgical management of abdominal aortic aneurysm.

Abstract

To review the natural history and the outcome of surgical repair of aortic abdominal aneurysm (AAA). An English and Scandinavian language search of papers between 1985-1997. After review, 132 papers with 54 048 patients remained. The mean postoperative mortality (30 days or in-hospital) for elective repair was approximately 5% and for emergency operations 47% (range 27-69%), both with significant heterogeneity. Results did not improve over time. Increasing age, presence of renal failure and atherosclerotic cardiac disease were identified as pre-operative risk factors. AAA expansion averaged 0.2-0.4 cm per year for aneurysms smaller than 4 cm, 0.2-0.5 cm for aneurysms 4-5 cm and 0.3-0.7 cm for those larger than 5 cm. The rupture risk at four years was 2, 10 and 22% respectively. The overview revealed several methodological problems in the reported studies. The results can be used as the basis of quality assurance or in decision trees or other models. Better reporting standards are needed.