[Patients operated on for aneurysms of the abdominal aorta: risk factors and survival].

Patients requiring radical cure of an aneurysm of the abdominal aorta often have associated conditions increasing the risk of peri-operative complications and immediate or short-term mortality. Detecting such associated lesions is thus of major importance to adapt patient management and treatment strategy. We assessed the following parameters associated with increased risk of peri-operative death in a series of 418 patients who underwent elective surgery for aneurysms of the abdominal aorta between 1986 and 1994: chronic renal failure (with or without dialysis), clinically apparent coronary artery disease, age over 75 years, defective left ventricular function. The effect of the characteristics of the aneurysm on immediate survival was also assessed. Aneurysm larger than 6 cm extending to the hypogastric artery had a higher operative risk. Post-operative survival was 96.5% at one month, 90% at one year and 87% and 69% at 2 and 5 years respectively. The predominant causes of death late in the post-operative period were vascular disease (coronary or neurologic) and cancer. Complications related to the operation were rare (1.5%). In conclusion, detection of operative risks allows 1) better patient selection for surgery, 2) adopting appropriate measures when the indication for surgery is retained, 3) establishing a follow-up and a screening protocol for detecting factors causing late deaths.