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[Vascular surgery in octogenarians]
H Van Damme1, S Smitz, R Larbuisson
1Université de Liège, Service de Chirurgie cardio-vasculaire.
Insights
Vascular disease prevalence rises with age. Surgical interventions for carotid stenosis, abdominal aortic aneurysms, and critical limb ischemia in octogenarians can be beneficial if perioperative risks are managed effectively.
Area of Science:
- Geriatric Medicine
- Vascular Surgery
- Cardiovascular Disease
Context:
- Peripheral vascular disease prevalence increases significantly in the aging population.
- Octogenarians exhibit high rates of carotid artery stenosis (8%), abdominal aortic aneurysms (4%), and critical limb ischemia (6%).
- Vascular aging presents unique challenges for surgical interventions.
Purpose:
- To review the literature on vascular aging and surgical outcomes in octogenarians.
- To evaluate the efficacy and risks of carotid endarterectomy, abdominal aortic aneurysm repair, and lower limb revascularization in patients aged 80 and older.
- To present recent surgical experiences in this demographic.
Summary:
- Carotid endarterectomy is a viable stroke prevention tool in octogenarians if perioperative stroke-mortality is below 3%.
- Abdominal aortic aneurysm repair in octogenarians, despite higher mortality (4.7% vs 2.7%), is justified to prevent fatal rupture.
- Limb salvage surgery is preferred over amputation for critical limb ischemia in octogenarians due to poor post-amputation adaptation.
Impact:
- Provides evidence-based guidance for managing vascular diseases in the elderly.
- Highlights the importance of individualized risk assessment for surgical decision-making in octogenarians.
- Contributes to improving outcomes for elderly patients undergoing major vascular procedures.
Abstract:
The prevalence of peripheral vascular disease increases with aging of the population. About 8% of the octogenarians present significant carotid artery stenosis, about 4% have an abdominal aortic anneurysm of 40 mm or more, and 6% suffer critical limb ischemia. Carotid endarterectomy in octogenarians is a valuable tool for stroke prevention, only if the combined perioperative stroke-mortality rate is lower than 3%. Operating an abdominal aneurysm of 50 mm or more in octogenarians is characterized by an operative mortality that is higher compared to that observed in a younger patient group (4.7% vs 2.7%). Aneurysm-surgery remains nevertheless justified, since it is the only way to prevent the evolution to rupture, that is almost fatal. Limb salvage surgery should always be considered for an 80-years patient with critical limb ischemia, since readaptation after major limb-amputation is not evident for octogenarians. An extensive review of literature is presented concerning vascular aging and results of carotid surgery, aneurysm repair and lower limb revascularization in octogenarians. The authors report their own recent experience with carotid surgery and aneurysm repair in patients aged 80 years or older.