Prognostic factors in the surgical treatment of aorto-iliac aneurysmal disease. Factors affecting survival and long-term results.

Factors governing the immediate and long-term outcome of surgical treatment of aorto-iliac aneurysmal disease were investigated in 182 elective and 116 ruptured consecutive cases. There was a 3.3% operative mortality for elective procedures and a 46.6% mortality for ruptured aneurysms. Long-term survival of elective resections was significantly reduced by age (0.01 less than p less than 0.025) and concomitant heart disease (0.025 less than p less than 0.05). Compensated renal insufficiency and chronic obstructive pneumopathy were not enough individually to preclude elective resection. In the emergency procedures the correlation of pre-, per- and postoperative factors to mortality was assessed: patient age (p = 0.01) and preoperative duration of symptoms less than 6 hours (p = 0.0076), arterial hypotension at the outset, during and at the end of operation (p = 0.0195; 0.0076 and 0.005 respectively), blood loss (p = 0.003), suprarenal extension of aneurysm (p = 0.0098) and intraperitoneal hemorrhage (p = 0.0094) were significant predictive factors in the univariate analysis. In the multivariate analysis peroperative duration of hypotension greater than 30 minutes was the strongest single independent discriminator (p = 0.0076), death being caused by myocardial ischemia in elderly patients, secondary to poorly tolerated severe hypovolemia.