Background: There are few reports in the literature describing the outcome for patients with abdominal aortic aneurysm who are not treated by surgical repair. This is in spite of the fact that this group of patients often defines the success of surgical treatment. The purpose of this report is to review those patients from St George Hospital Kogarah who have been rejected for surgical therapy and to examine the long-term outcome and mode of demise of these patients.
Methods: At the end of December 1992 we completed a computerized list of all patients seen at St George Hospital Kogarah with abdominal aortic aneurysm. Since that time we have continued to accrue patients to this list and obtain follow-ups prospectively. End points examined in this study were aortic aneurysm transverse diameter, sex, age, intercurrent illnesses, reasons for not undertaking surgical treatment, length of survival and cause of death.
Results: The mean age of patients in this series was 77 +/- 8.29 years (SD). Survival at yearly intervals for 5 years in our 101 patients were 69, 55, 44, 35 and 33%, respectively. For patients with an abdominal aortic aneurysm of < or = 5 cm, the 5-year survival rate was 42% while for patients with an abdominal aortic aneurysm of > 5 cm, the 5-year survival rate was 25%. There were 66 deaths in this series; 40% were due to cardiopulmonary events and 30% were due to ruptured abdominal aortic aneurysm. The median time between presentation and death was 12 months.
Conclusion: The patients from this report were significantly older than those reported from previous series. We believe that it will become increasingly important to develop methods of selection of patients for current and newer modalities of treatment for abdominal aortic aneurysm. It will be increasingly important for groups offering these treatments to be able to explain to patients what their prognosis is likely to be should they not be selected for those treatments.