Abdominal aortic aneurysmectomy in octogenarian patients
Glock, Y.; Smile, E.; Dalous, P.; Roux, D.; Fournial, G.; Cerene, A.; Puel, P.
Journal of Cardiovascular Surgery 31(1): 71-76
1990
ISSN/ISBN: 0021-9509 PMID: 2324187 Document Number: 367219
The authors report 56 patients, 80 years of age or older who had an abdominal aortic aneurysm (AAA): twenty-seven were operated upon as emergencies, 7 with intra-peritoneal (Group I) and 20 with retro-peritoneal rupture (Group II). Twenty-nine underwent elective surgery (Group III). Renal pulmonary and cardiac disease are frequent in octogenarian patients. The surgical repair consisted of 40 knitted bifurcated grafts and 16 aorto-aortic woven grafts. The overall in-hospital mortality rate is high (28.5%: 16 patients) essentially in "emergency" surgery: 71% for the seven Group I patients and 45% for the twenty Group II patients. The in-hospital mortality rate of 6.9% for the Group III of "elective" procedure is higher than the mortality rate of patients of all ages operated on for asymptomatic AAA in our institution which is 4.3%. Once a patient has been operated on successfully his life expectancy tends to parallel that of a normal population for his age group. These results can be improved with preventive measures such as elective surgery for asymptomatic AAA with a diameter of 6 cm or more. Operative contraindications are severe congestive heart failture, advanced pulmonary disease or neoplastic disease. The age "per se" is not a contraindication to aneurysmectomy. Physiologic rather than chronologic age should determine the selection for AAA in the over-80 age group. CT scans and MR are safe, fast and non-invasive preoperative examinations for AAA.