During the past 19.5 years, we performed open repairs of 666 non-ruptured abdominal aortic aneurysms（AAA）and iliac artery aneurysms regardless of the patient’s age, previous abdominal surgery, or comorbidities. To evaluate our strategies, we reviewed octogenarians and patients with previous laparotomy, dividing them into several groups.（1）Octogenarians were divided into the EO-group（extremely-old patients, 85 years old or older:n＝56）and the O-group（octogenarians, younger than 85 years old:n＝113).（2）All cases operated by transabdominal approach（n＝661）were divided into the A-group（with previous laparotomy:n＝164）and the B-group（without laparotomy:n＝497).（3）A-group was also divided into subgroups according to the kind of previous surgery:M-group（stomach or gall bladder surgery:n＝120), C-group（colorectal surgery:n＝20), Ao-group（aortic surgery:n＝16), and S-group（colonic or urinary stoma constructing surgery:n＝6). We introduced our clinical pathway in January 2000 and non-heparin technique in November 2000 for all AAA repairs. Non-heparin technique was revised in January 2003, excluding AAA with occlusive disease after several thrombotic complications. A comparison between EO-group and O-group proved that there was a significant difference only in aneurysmal diameter and frequency of renal impairment. Mean operation time（201±56min vs 210±52min), intraoperative blood loss（442±338ml vs 430±242ml), postoperative length of stay（9.4±5.0 days vs 8.2±2.8days), and hospital mortality（0% vs 0.9%）were the same in both groups. Analyses of the consequences of previous laparotomy showed that A-group needed significantly longer exposure time（74±27min vs 63±23min:p＝0.00001）and operation time（218±55min vs 204±53min:p＝0.004）than B-group, but intraoperative blood loss（453±370ml vs 449±274ml）and transfusion rates（6.7% vs 8.5%）were the same in both groups. Because the data of M-group and C-group were similar to each other as well as those of Ao-group and S-group, we compared the perioperative data between M＋C-group and Ao＋S-group. Concerning exposure time, M＋C-group required 6 min more than B-group and Ao＋S-group 37 min more than M＋C-group. The operation time of M＋C group was 8 min longer than B-group and that of Ao＋S-group was 45 min longer than M＋C-group. Although there were significant differences in intraoperative blood loss（396±247ml vs 820±701 ml:p＝0.009）and transfusion rates（4.2% vs 22.7%:p＝0.001）between M＋C-group and Ao＋S-group, postoperative length of stay（8.1±2.2 days vs 10.2±7.5 days）was almost the same, and the majority of patients（97.2% and 100% of respective groups）were discharged. Our experiences with clinical pathway and non-heparin technique suggest that open repair of AAA should not be refrained only for extremely old-aged patients or patients with previous laparotomies.
Jpn. J. Cardiovasc. Surg. 42:260-266（2013）
Keywords：abdominal aortic aneurysm, octogenarian, previous laparotomy, clinical pathway, non-heparin