Abdominal aortic aneurysms: a clinical and autopsy study of 408 patients.

The material consisted of 408 patients with abdominal aortic aneurysms between 1959-1969 (Period I) and 1970-1979 (Period II). Of the aneurysms 135 were ruptured of which 65 were operated on and 70 revealed at autopsy. Autopsy revealed that in Period I an incorrect diagnosis had been made in 12/24 (50%) of those cases in which rupture was the cause of death; in Period II an incorrect diagnosis was made in 6/46 (13.3%) of similar cases. During Period I, 16/26 (62%) of those operated on for aneurysms were rupture cases; during Period II rupture cases were 49/129 (38%). The mean age of patients operated on for rupture was 66 years (mean age of elective patients 64 years). The operative mortality rate in rupture cases was 63% (41/65): eleven of these patients died during the operation and 30 died during the postoperative period most often on account of late sequelae of the primary shock period or some type of cardiovascular complication. Among patients older than 70 years the mortality rate was 89%; in the younger age group 49%. All patients with free peritoneal rupture died. Preoperative shock, massive bleeding during the operation and duration of operation correlated with the high operative mortality rate. In elective cases the hospital mortality rate was 7%. Myocardial infarction was the most important cause of death. The mortality rate did not correlate with age, perioperative bleeding or the duration of the operation.