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Objective: The purpose of this study is to assess the outcomes of open abdominal aortic aneurysm (AAA) repair over the past decade at a single academic institution.
Methods: Patients undergoing open AAA repair from January of 2002 to December of 2011 were identified. Patient demographics, intraoperative techniques and clinical outcomes were analyzed. The primary endpoint was 30-day mortality.
Results: A total of 368 patients underwent open AAA repair. There were 252 (71.1%) males and the mean age was 70.1 +/- 0.43 years. The AAAs were infrarenal (IR) in 211 (57.3%) patients, juxtarenal (JR) in 130 (35.3%), and suprarenal (SR) in 27 (7.3%). The mean maximal aneurysm diameter was 6.09 +/- 0.08 cm. Patient demographic information is summarized in Table 1. For IR AAAs, an open approach was undertaken due to unsuitable anatomy for endovascular repair in 182 (86.3%) patients, surgeon/patient preference in 12 (5.7%) and the need for an adjunctive procedure in 16 (7.6%). Overall, the retroperitoneal approach was used in 64.7% (238) of cases with 57.8% (122) of IR, 72.3% (94) of JR and 81.5% (22) of SR patients. A tube graft was used in 222 (60.3%) cases. The mean follow-up was 1130.9 days for the entire cohort. There was a trend towards higher perioperative complication rates in SR patients with myocardial infarction (18.5% SR, 7.69% JR, 5.69% IR), dysrhythmia (29.6% SR, 10% JR, 8.1% IR), need for inpatient hemodialysis (7.4% SR, 3.8% JR, and 3.8% IR), bleeding (11.1% SR, 7.7% JR, 3.3% IR) and any complication (37.0% SR, 30.8% JR, 30.3% IR). Despite the higher complication rates, SR patients did not have a higher 30-day mortality rate (3.70% SR, 5.39% JR, 3.79% IR).
Conclusions: With the introduction of endovascular techniques, open AAA repair is often reserved for those with complex aortic anatomy. Despite this, open aortic reconstruction continues to be an effective treatment modality with acceptable morbidity and mortality.

Table I: Patient Demographics

	Total N (%)	Infrarenal N (%)	Juxtarenal N (%)	Suprarenal N (%)
Number of patients	368	211 (57.3)	130 (35.3)	27 (7.3)
Gender (%male)	252 (68.5)	150 (71.1)	87 (66.9)	15 (55.6)
Age (years), +/-SEM	70.1, 0.43	69.8, 0.59	70.7, 0.69	70.0, 1.48
Coronary Artery Disease	223 (60.6)	123 (58.3)	84 (64.6)	16 (59.3)
Chronic Obstructive Pulmonary Disease	109 (29.6)	56 (26.5)	42 (32.3)	11 (40.7)
Diabetes Mellitus	68 (18.5)	41 (19.4)	22 (16.9)	5 (18.5)
Hypertension	306 (83.2)	173 (82.0)	112 (86.2)	21 (77.8)
Smoking	239 (65.0)	135 (64.0)	84 (64.6)	20 (74.1)
Size (cm), +/-SEM	6.09, 0.08	5.96, 0.11	6.22, 0.12	6.43, 0.36