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Abdominal aortic aneurysm surgery in octogenarians

S S Soisalon-Soininen1, J A Salo, S P Mattila

  • 1Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.

VASA. Zeitschrift Fur Gefasskrankheiten
|April 16, 1998
PubMed
Summary

Elective surgery for abdominal aortic aneurysms (AAA) in octogenarians has similar survival rates to younger patients. Non-surgical treatment of asymptomatic AAA in the elderly leads to significantly lower survival rates.

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Area of Science:

  • Vascular Surgery
  • Geriatric Medicine
  • Public Health

Background:

  • Symptomless abdominal aortic aneurysms (AAA) in the elderly present a treatment dilemma.
  • Deciding on surgical intervention requires careful consideration of patient age and aneurysm status.

Purpose of the Study:

  • To compare the outcomes of surgical versus non-surgical treatment for abdominal aortic aneurysms (AAA) in octogenarians.
  • To evaluate the risks and benefits of elective versus emergency surgery for AAA in elderly patients.

Main Methods:

  • Retrospective review of 77 octogenarians and 692 younger patients with infrarenal abdominal aortic aneurysms (AAA).
  • Comparison of 30-day mortality rates for emergency (ruptured or impending rupture) and elective surgery.
  • Survival analysis for non-surgically treated octogenarians compared to electively treated patients and a matched population.

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Main Results:

  • Emergency AAA surgery was more frequent and had higher 30-day mortality in octogenarians compared to younger patients.
  • Elective AAA surgery for symptomless aneurysms showed comparable 30-day mortality rates (8%) in octogenarians and younger patients.
  • Non-surgically treated octogenarians had significantly lower survival rates, with a median survival of 2.5 years, and 50% died from aneurysm rupture.

Conclusions:

  • Active, elective surgical treatment of abdominal aortic aneurysms (AAA) is supported for elderly patients.
  • Delaying treatment for asymptomatic AAA in octogenarians leads to poorer outcomes.
  • Surgical intervention for AAA in the elderly, when elective, is a viable and beneficial option.