Abdominal aortic aneurysms: recent experience with 210 patients.

In the 6 1/2 years ending June 1977, 210 patients with abdominal aortic aneurysms underwent operation at Toronto Western Hospital; 160 aneurysms (76%) were unruptured and 50 (24%) were ruptured. In the patients with unruptured aneurysms the mean age was 68 years; the oldest was 91, and 12 were more than 80 years of age. The overall hospital mortality was 5.6%. Death in hospital occurred in 1 (1.2%) of the 83 asymptomatic patients, 4 (7.4%) of the 54 symptomatic patients and 4 (17.0%) of the 23 patients for whom operation was considered urgent. In the patients with ruptured aneurysms the mean age was 71 years; the oldest was 90, and five were more than 80 years of age. The overall hospital mortality was 54%. The morbidity and mortality were analysed; in particular the reasons for the markedly variable hazard of operations for the three categories of unruptured aneurysm were sought. The surgical literature is confusing because of the interchanging use of the words unruptured, elective and symptomless. The current philosophy management and technique of operation in a large cardiovascular surgery service with many trainees are presented and a plea is made for a standardized and simplified operation, always performed with three assistants helping the operating surgeon.