Literature review of surgical management of abdominal aortic aneurysm

Objectives; to review the natural history and the outcome of surgical repair of aortic abdominal aneurysm (AAA). Design: an English and Scandinavian language search of papers between 1985-1997. Results: after review, 132 papers with 54 048 patients remained. The mean postoperative mortality (30 days or in-hospital) for elective repair was approximately 5% and for emergency operations 47% (range 27-69%), both with significant heterogeneity. Results did not improve over time, Increasing age, presence of renal failure and atherosclerotic cardiac disease were identified as pre-operative risk factors. AAA expansion averaged 0.2-0.4 cm per year for aneurysms smaller than 4 cm, 0.2-0.5 cm for aneurysms 4-5 cm and 0.3-0.7 cm for those larger than 5 cm. The rupture risk at four years was 2, 10 and 22% respectively. The overview revealed several methodological problems in the reported studies. Conclusions: the results can be used as the basis of quality assurance or in decision trees or other models. Better reporting standards are needed.