Seguimiento a cinco años de los pacientes ASA IV intervenidos de aneurisma de aorta infrarrenal

Summary Objectives One of the arguments used to justify the use of endoprostheses in patients with aortic aneurysms is so that they attain an ASA IV classification at preoperative risk assessment. To defend or reject this criterion we make a retrospective study of such patients who were operated on between 1991 and 1995 to ascertain their follow-up course. Patients and methods 36 patients of a total of 126 operated on for infra-renal aortic aneurysms between 1991 and 1995 were considered to be ASA IV. We excludedpatients who had emergency operations and those who required supra-renal clamps. The average age was 68.6 and only one patient was a woman. The main risk factors were smoking and hypertension. The commonest associated disorder was cardiopathy, especially ischaemic, and chronic airway restriction. Results The hospital mortality was 2.7%. The mortality after one year was 8.3%, after three years 36% and after five years 55.5%. The most frequent cause of death was cancer followed by myocardial infarct. Conclusions The operative mortality of patients with ASA IV was low in our series. It was acceptable and similar to that of ASA III. The ASA classification has low predictive value for surgical mortality. Both conclusions were due to excessive evaluation of risk in some of our patients. The ASA classification is not, therefore, a suitable method for assessing whether to use endoprosthetic treatment of the aorta. This should be based on anatomical criteria within a controlled study.