Changing factors influencing abdominal aortic aneurysm repair.

A personal series of 354 abdominal aortic aneurysmectomies has been analyzed, consisting of 67 in 1961-1969, 152 in 1970-1975 and 135 in 1976-1980. Mean age has increased to 68.1 years with 81% over 60. Aneurysm size and associated diseases have remained constant. Operative mortality for non-ruptured aneurysms has decreased from 12% to 4.1% to 1.8% and for ruptured aneurysms has been 71%, 45% and 52%. In the non-ruptured group renal, pulmonary and cardiac complications and deaths have been reduced. Early graft complications have been 1 in the last 135 and 10 in the previous 152 operations, associated with 36% aorto-bifemoral and tube repairs in the last 5 years. Pre-operative preparation to minimize associated disease symptoms, sophisticated operative monitoring and fluid replacement and improved surgical techniques combined with intensive post-operative care have evolved to produce better results in elective aneurysm repair.