Infra-Renal Abdominal Aortic Aneurysm with Surgical Outcome following open technique ; A Pilot Study.

Abstract

BACKGROUND: Infra-Renal Abdominal Aortic Aneurysm presently is managed by Endovascular as well as Open technique we managed these patients by open surgical technique.

OBJECTIVE(S): To study To study The clinical profile of IAAA patients To study  etiology, Mode of presentation  of IAAA  patients To study Morbidity, complications, and in-hospital  Mortality  with the surgical modality of treatment 

STUDY DESIGN: Prospective as well as Retrospective study.PARTICIPANTS: 60 patients with Infrarenal AAA were included in the study group and were divided into patients with leaking (12 ) and nonleaking aneurysms  (48).

METHODS: All patients were evaluated as per protocol and divided into symptomatic, asymptomatic, and leaking IAA Aneurysms. All were subjected to transperitoneal excision and revascularisation by Dacron Y / Tube Graft. RESULTS: Among,60 patients 12 patients (20%)  had evidence of aneurysmal rupture,48 patients (80%) had unruptured aneurysms. The mean operative time in the emergency group was 4.7 hours (range 3–6 hours) and 4.3 hours (range 3–7 hours) in an elective group with an overall average of 4.5 hrs. The mean duration of ICU stay was 4 (range 1–8) days and 2 days (range 1–5) for emergency and elective cases respectively. In-hospital mortality was 2/8(25%) in group 1(emergency settings) which included a total of 12 patients among whom 4 succumbed before reaching OT  during resuscitation and 8 were operated out of whom 2 died after surgery. The mortality in the elective group was  2/44 (4.5%) . Post-operative morbidity was seen in 2/8(25%) of group 1  which included acute lower limb ischemiain one managed by timely embolectomy and colonic ischemia in another who required colonic resection. In group 2, 3/44 (6%) which included burst abdomen (1), pneumonia (1) acute limb ischemia (1)  which was successfully treated by embolectomy and fasciotomy.      The average aortic cross-clamp time in an emergency and electively operated patients was  40min and 50 min respectively. The average ICU  / Hospital stay for emergency and electively operated patients was 4/ 9 days and 2/7days  respectively. The amount of blood transfusion was variable and was determined by multiple factors which included baseline Hb, amount of leaking, hemodynamic stability, and was found more in an emergency group than the elective group with an average of  1050 ml in the emergency group and 350 ml for the elective group. 

CONCLUSION: Open repair of infra-renal abdominal aortic aneurysm is an excellent modality of treatment with acceptable mortality and morbidity rates.IMPLICATIONS: Open repair of infra-renal abdominal aortic aneurysm is an excellent modality of treatment with acceptable mortality and morbidity rates.