Abstract

Manabu Shiraishi, Kei Aizawa, Yasuhito Sakano, Yuichiro Kaminishi, Shin-ichi Ohki, Tsutomu Saito, Yoshio Misawa

This study aimed to determine the procedure-related major morbidity of infrarenal abdominal aortic aneurysm (AAA) repair, to investigate the changes in perioperative laboratory values, and to clarify the degree of physical strain of surgery and specific independent predictive factors for major morbidity. In addition, in the case of endovascular aneurysm repair (EVAR), we weighed how occlusion of the internal iliac artery related to physical strain of surgery in terms of laboratory values. We retrospectively evaluated patients who were treated at Jichi Medical University Hospital. Methods: Consecutive patients with an AAA (excluding ruptured AAA) between April 2007 and August 2010 were studied. The effects of various patient- and operation-related variables on outcomes (major morbidity, duration of stay in hospital, renal insufficiency, and endoleakage) were assessed by univariate and multivariate analyses. Results: Overall in-hospital mortality was 0.4%. Statistically significant differences, mostly in favor of EVAR, were observed in the intraoperative and postoperative data. The presence of an internal iliac artery occlusion did not affect the perioperative laboratory data. Of various patient- and operationrelated variables for each outcome, the relative factors were duration of operation, blood loss, white blood cells, C-reactive protein, lactate dehydrogenase, creatine phosphokinase, and potassium. In multivariate logistic analysis, blood loss, C-reactive protein, creatine phosphokinase, and potassium were significantly related to each outcome. Conclusions: Both elective open repair and EVAR can be safely performed in patients with an infrarenal AAA. EVAR has perioperative advantages of reduced blood loss and blood transfusions as well as a decreased duration of stay in hospital. In particular, we identified specific independent relative factors of laboratory values for major morbidity, duration of stay in hospital, renal insufficiency, and endoleakage