Is 80 years too old for aneurysmectomy?
T. F. O'Donnell, R. C. Darling and R. R. Linton
The records of 111 patients, 80 years of age or older, with a primary
diagnosis of abdominal aortic aneurysm(AAA) showed that 86 patients
underwent aneurysm resection and grafting. Ruptured AAAs (n=30) were
associated with an operative mortality of 74%. By contrast, AAA resection
in the expanding aneurysm group (n=19) and in the elective surgery group
(n=44) was associated with a 10% and 2% mortality, respectively. Thus,
resection of a nonruptured AAA in 63 octogenarians was carried out with an
overall mortality of 4.7%. While nearly half of the patients had cardiac
disease detected preoperatively, the elective group demonstrated a low
incidence of previous myocardial infarction (7%) and congestive heart
failure (8%). Concomitantly, the incidence of myocardial infarction (6%)
and congestive heart failure was relatively low after AAA resection.
Significant postoperative oliguric azotemia was observed in only 5% of the
nonruptured patients. Long-term survival was comparable to that of the
general population over the age of 80 years. The quality of life enjoyed by
these patients was not adversely affected by AAA resection. By contrast,
50% of patients treated conservatively died of ruptured AAA. Physiologic
rather than chronologic age should determine selection for AAA resection in
the octogenarian.
