Abdominal aortic aneurysmectomy in octogenarian patients

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Aortic Aneurysm Research

Background:

• Octogenarian patients frequently present with abdominal aortic aneurysms (AAA), often complicated by comorbidities like renal, pulmonary, and cardiac disease.
• Surgical repair of AAA in this age group presents unique challenges due to increased physiological stress.

Purpose of the Study:

• To evaluate the outcomes of emergency versus elective surgical repair of abdominal aortic aneurysms (AAA) in patients aged 80 years and older.
• To determine the impact of comorbidities and surgical approach on in-hospital mortality in octogenarian AAA patients.

Main Methods:

• Retrospective analysis of 56 patients aged 80+ undergoing AAA repair.
• Classification of patients into emergency (intra-peritoneal and retro-peritoneal rupture) and elective surgery groups.
• Comparison of in-hospital mortality rates across different surgical groups and with historical data.

Main Results:

• Overall in-hospital mortality was 28.5%, significantly higher in emergency cases (71% for Group I, 45% for Group II) compared to elective cases (6.9%).
• Elective repair mortality (6.9%) exceeded the institutional rate for all ages (4.3%) for asymptomatic AAA.
• Post-successful repair, life expectancy approached that of the age-matched general population.

Conclusions:

• While age alone is not a contraindication, physiological status is crucial for selecting octogenarians for AAA repair.
• Preventive measures, including elective surgery for asymptomatic AAA (≥6 cm diameter), can improve outcomes.
• Contraindications include severe heart failure, advanced pulmonary, or neoplastic disease.