Factors affecting late survival after elective abdominal aortic aneurysm repair

Background: The late prognosis after repair of an abdominal aortic aneurysm (AAA) may be affected by atherosclerosis, which involves various organs including the aorta. Methods: The influence of organ dysfunction and atherosclerosis on the long-term survival of 338 consecutive patients undergoing successful elective AAA repair between 1980 and 1997 was analysed using Cox hazards model. Survival rate was compared with that of 349 patients undergoing successful revascularization for aortoiliac occlusive disease (AIOD) during the same interval. Results: Renal dysfunction and a previous history of cerebrovascular events were important variables predicting late death (risk ratio 1.980 and 1.903 respectively), while a history of cardiac disease predicted only cardiac-related death. The survival rate in patients with normal renal function was significantly better than that in those with renal dysfunction (P = 0.0371). Similarly, the survival rate was significantly better in patients without a history of previous cerebrovascular events (P = 0.0414). The survival rate after AAA repair was nearly identical to that of age- and sex-matched patients with grade II or III symptoms who had surgery for AIOD. Conclusion: Advanced atherosclerosis with underlying organ dysfunction is a true determinant of longterm survival following elective repair of AAA.