Late prognosis of surviving patients after open surgical repair of a ruptured abdominal aortic aneurysm

Introduction and objectives: several studies have looked into the late prognosis of patients after elective abdominal aortic aneurysm (AAA) repair, but there is little data regarding those who survive a ruptured AAA. Our aim is to analyze the late survival and incidence of cardiovascular events in these patients. Material and methods: we performed a retrospective analysis of a prospective cohort of patients who had survived the open repair of a ruptured AAA between 1988 and 2014. We included the patients who had survived at least 3 months after the procedure and of whom we had clinical follow-up of at least a year. We registered demographic data, cardiovascular risk factors, comorbidity, some surgical details, late deaths and their causes, cardiovascular events and graft-related complications. We analyzed the survival and freedom from cardiovascular event rates using Kaplan-Meier curves and Mantel-Cox regression. Results: we studied 45 patients (42 men), with a mean age of 70 years (SD 8.3; range 54-89) at the time of the surgical repair. The maximum mean diameter of the ruptured AAA was 80.1 mm (SD 21.3; range 51-135). Mean follow-up was 7 years (SD 5.8; range 0.3-21.5). 25 patients (55,6%) suffered from late cardiovascular events: 13 cardiological (28.9%), 5 neurological (11.1%), and 8 peripheral vascular events (17.8%), with a rate of 0,3 events/patient-year (SD 1.7; range 0-3.5). 26 patients (57.8%) died during follow-up, with cardiovascular events as the main cause (n = 9; 20%). There were 3 graft-related complications (6.7%), and 2 graft-related deaths (4.4%). The cohort's survival rates were 86%, 66% and 53% at 2, 5 and 10 years respectively, with freedom from cardiovascular event rates of 79%, 65% and 40% for the same time periods. Age and cardiac disease increased the risk of late death and cardiovascular events respectively (p <= 0,01). Conclusions: late survival after successful open repair of a ruptured AAA is good, but these patients suffer an increased incidence of cardiovascular events throughout their lives. Graft-related complications are rare.