Aneurysms of the infrarenal abdominal aorta: principles and results of surgical treatment.

With the surgical treatment of closed abdominal aortic aneurysms, the patient can have long-term survival and the danger of rupture can be avoided. Surgical repair on asymptomatic closed aneurysms can be performed with a very low risk (a mortality rate of below 1%). The main prerequisite for such protective surgery is an early diagnosis, best done by a routine check-up of all elderly people suffering from arterial hypertension, peripheral occlusive disease or other signs of arteriosclerosis. Computerized tomography (CT) and the ultrasound technique have gained a predominant position in such protective screening programs. Through the standardization and simplification of the operative techniques, surgical repair has been made simpler, safer and shorter, and the operative risk for patients with intact aneurysms has been remarkably reduced. A ten-year retrospective evaluation of 162 operated patients demonstrates a reduction in operative mortality from 14.3% to 2.8% in the group of patients with nonruptured aneurysms in the last period (1975-1979). On the other hand, progress has been made much more limited in surgery for ruptured aneurysms (operative mortality only reduced from 61.1% to 52.3%). The repair of closed or ruptured aortic aneurysms should be mainly restricted to special units with a highly trained surgical team. This type of surgery should no longer be the subject of occasional intervention by general surgeons.