What are the long-term results of conventional open surgical repair of abdominal aortic aneurysms?

Purpose: To determine the long-term results of conventional open surgical repair of abdominal aortic aneurysms (AAAs) and the prevalence of late arterial abnormalities.

Methods: CT scan follow-up was obtained between 8 and 9 years after elective AAA repair on a cohort of patients enrolled in the Canadian Aneurysm Study, a registry that originally consisted of 680 patients. A request for CT follow-up was sent to the responsible surgeon in 1994 when 251 patients were alive and available. Ninety-four of the 251 patients agreed to undergo an abdominal and thoracic CT scan, and each scan was interpreted independently by two vascular radiologists.

Results: The aorta was analysed in five defined segments, and an aneurysm was defined as > 50% enlargement from the expected normal value as defined in the Reporting Standards for Aneurysms. Using this strict definition, 64.9% of patients had an aneurysm, but the abnormality was considered a possible indication for surgical repair in 13.8%. Of the 39 patients who had an initial repair with a tube graft, 12 (30.8%) were found to have an iliac aneurysm and 6 (15.4%) were considered to be of possible surgical significance. The median graft size at the time of operation was 18 mm, which increased to a median size of 22 mm at follow-up. Fluid or thrombus around the graft was observed in 28%, and bowel was intimately associated with the graft in 7%.

Conclusions: The longterm results of conventional open surgical repair is durable. CT scan follow-up between 8 and 9 years postoperatively often demonstrates aortic and iliac abnormalities, but the majority are not clinically significant. On the basis of these findings, a routine CT scan of the abdomen and chest is recommended after 5 years. This study provides a population based study for comparison with the longterm results of endovascular repair.