[Abdominal aortic aneurysm--is a conservative attitude still justified? Experiences with 56 emergency and 128 elective surgical patients from the anesthesiological and vascular surgery viewpoints].

A retrospective analysis was undertaken of a consecutive series of 184 patients operated on between 1.1. 1984 and 31. 12. 1985 for aneurysm of the abdominal aorta. Rupture of the aneurysm had occurred in 56 patients (aged 70 +/- 9 yrs), 47 (aged 66 +/- 9 yrs) had symptoms of an aneurysm, and 81 (aged 66 +/- 5 yrs) were operated on electively. The highest peri-operative hospital mortality rate, of 35.9%, was among the group with rupture (compared with 8.5% for the symptomatic group and 1.2% for the elective one). The period of intensive care in surviving patients was highest in the rupture group, at 8 +/- 17 days, compared with 3 +/- 2 in the symptomatic and 3 +/- 3 days in the elective group. Duration of postoperative hospital stay was 20 +/- 13, 15 +/- 7 and 13 +/- 6 days, respectively, in the three groups. Half of the patients also had arterial obstructive disease, arterial hypertension and/or coronary heart disease (25% had had an infarct according to the history, 8% more than one). A third of the patients received or should have received treatment for lung or respiratory tract disease, heart failure and/or cardiac arrhythmias. The thirty-fold increase in mortality rate for an emergency operation over that for elective surgery, together with the higher costs and longer hospital treatment, as well as the reduced probability of survival with conservative treatment speak for an aggressive approach towards elective surgery after optimal pre-operative treatment.