Evolución del perfil de los pacientes sometidos a cirugía abierta de aneurisma de aorta abdominal en la era endovascular

Introduction: The increasing use of endovascular repair in the treatment of abdominal aortic aneurysm (AAA) may have modified the profile of patients undergoing open repair (OR), as well as the results. Objective: The aim is to evaluate the clinical and anatomical characteristics of patients with AAA undergoing elective OR in our department over the last few years, and their relationship with the post-operative results. Methods: A retrospective study was conducted on patients undergoing elective AAA OR between 2008 and 2014 and who had a pre-operative computed tomography (CT) scan available. The following variables were recorded: Demographics (age, gender), comorbidities (cardiac, respiratory, renal), pre-operative medication, anatomical characteristics (proximal neck diameter, length, calcification, thrombus, and angulation), and blood test parameters. A hostile proximal infrarenal aortic neck was defined as: <10 mm length and/or >50% circumference thrombus and/or >50% calcification and/or >60 degrees angulation. The mortality, complications, re interventions and re-admissions were recorded. The sample was divided into 2 periods: 1 (2008-2011) and 2 (2012-2014). Results: A total of 107 patients were included, with mean age of 69.26 years (SD =6.239). Mean follow-up was 28.39 months (SD =23.13), with a survival rate of 78.6% (n = 12) at 64 months. It was found that there was a greater incidence of hostile neck (45.2 vs. 64.6%; P<.05) and proximal neck calcification >50% (8.1 vs. 24.1%; P<.05) in the second period of time. During period 2 a greater number of blood transfusions were required (26.2 vs. 56.9%; P<.05), but fewer cardiac complications were recorded during the first 30 days post-surgery (16.7 vs. 4.6%; P<.05). The mortality, re-intervention, and re-admission rates were similar in both periods (P>.05). Conclusion: In our series, the patients with AAA who underwent elective OR showed increasingly less favourable anatomical characteristics, but this does not lead to increased postoperative morbidity and mortality. (C) 2015 SEACV. Published by Elsevier Espana, S.L.U. All rights reserved.