Two year prospective analysis of the Oxford experience with surgical treatment of abdominal aortic aneurysm.

During the two years from 1 November 1985 to 31 October 1987, 177 patients were admitted to a hospital in Oxford with the diagnosis of abdominal aortic aneurysm (AAA). The aneurysm had ruptured in 88 patients, of whom 75 underwent emergent surgical treatment, yielding an operative mortality rate of 36 per cent. Of the 13 patients who did not have surgical treatment, two died before transfer to the operating room; in the other 11 patients, a deliberate decision was made not to undertake surgical treatment--in ten patients, the reason was an age of 85 years or more and in one patient, severe debilitating Parkinson's disease. Emergent operations were done upon another 15 patients--11 who had acute aneurysm and four in whom symptoms were not caused by an aneurysm. Emergent operations for ruptured or acute aneurysms represented 55 per cent of all operations for AAA. This high proportion and large number of emergent operations is in marked contrast with the experience of comparable specialist vascular surgical units in the United States. The 24-fold difference in mortality rates between surgical procedures performed electively and for ruptured aneurysm suggests that a considerable impact on over-all mortality could be achieved by a substantial increase in referral of patients