Perioperative Hypotension and Survival After Elective AAA Repair

Background: An abdominal aortic aneurysm (AAA) is a localized dilatation of the infrarenal aorta that, when it meets critical criteria, can rupture and cause a vital emergency, requiring immediate surgery with a mortality rate close to 85%(1). Also, symptomatic AAA and/or imminent rupture is a surgical emergency that should be recognized and treated promptly. Elective procedures are usually performed in patients with AAA with a diameter greater than 5.5 cm in men and 5.0 cm in women(2,3). There are different techniques for the surgical repair of AAA, which are divided into two main groups: endovascular and open procedures. The endovascular procedure offers an early survival benefit, better postoperative recovery, and fewer incision-related complications as it is a minimally invasive procedure. However, it requires more re-interventions, but most are mainly minor endovascular procedures. In contrast, an open approach has a better 15-year late survival benefit, associated with greater graft durability, a lower rate of re-interventions, and the additional advantage of being more affordable (4-7). Several risk factors have been established around surgical procedures that may affect the outcome, including preoperative and intraoperative hypotension. Preoperative hypotension is one of the most crucial factors, especially when talking about ruptured AAA, where it is present with a high frequency and has been seen as an association with mortality with an AOR of 3.28 (CI 1.75-5.41; P \< .001) (8). For intraoperative hypotension, a study showed that it increased the 30-day mortality after an elective open repair of AAA with an OR of 6.61 (CI 0.71-61.07; p = 0.05). Also, it has been associated with liver dysfunction (p \< 0.001) and colonic ischemia (P=0.021) (9-11). However, the frequency and effects of postoperative hypotension in open and endovascular AAA surgery have not been described in the literature despite the everyday use of vasopressor medications (48%) in the im