Document Detail


Open abdominal aortic aneurysm repair is feasible and can be done with excellent results in octogenarians.
MedLine Citation:
PMID:  21030199     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of this study was to determine the feasibility of open abdominal aortic aneurysm (AAA) repair in octogenarians during a time period of multiple commercially available endografts, in which only proximal aneurysms or the most challenging anatomy are not stented.
METHODS: A retrospective review was performed of all patients aged ≥ 80 years undergoing open AAA repair over a 7-year period (2003-2009) at a single academic medical center. Demographic data, aneurysm characteristics, comorbidities, operative results, perioperative complications, length of stay, and late outcomes were analyzed.
RESULTS: Sixty-five patients were identified (men, n = 27) with a median age of 82 years (80-89 years old). Mean aneurysm size was 6.7 cm. Morphology consisted of type IV thoracoabdominal (n = 19), suprarenal (n = 14), pararenal (n = 19), and infrarenal (n = 13). Eighty-five percent of cases were performed electively. A tube graft was used in 58 patients, and the left renal artery was bypassed in 33 patients. Fifty-two patients required a suprarenal or supraceliac clamp, with a mean proximal clamp time of 22 minutes. Mean estimated blood loss was 1800 mL. Mortality was 6% at 30 days. Overall morbidity was 42%, most commonly an arrhythmia (25%). Major complication rate was 18%. Median intensive care unit (ICU) and hospital length of stay was 3 and 9 days, respectively. Sixty-one percent of patients were discharged directly home. Six patients developed acute renal failure, although none progressed to dialysis. Mean serum creatinine was 1.3 mg/dL preoperatively and 1.5 mg/dL at discharge. One patient developed bowel necrosis (sigmoid colon) requiring resection. Follow-up ranged from 1 to 81 months (mean, 24 months). Three-year survival was 79%.
CONCLUSION: With an increasing population of elderly patients, vascular surgeons are continually confronted with patients over 80 years of age. Our patients consisted of those not anatomically suitable for endovascular aortic aneurysm repair. Despite a predominance of proximal aneurysms, our results demonstrate excellent rates of morbidity and mortality. Thus, open AAA repair can be done safely and effectively in octogenarians, and age alone should not exclude this form of repair.
Authors:
Edward Y Woo; Brant W Ullery; Jeffrey P Carpenter; Grace J Wang; Ronald M Fairman; Benjamin M Jackson
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Publication Detail:
Type:  Journal Article     Date:  2010-10-27
Journal Detail:
Title:  Journal of vascular surgery     Volume:  53     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-31     Completed Date:  2011-03-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  278-84     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. wooe@uphs.upenn.edu
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MeSH Terms
Descriptor/Qualifier:
Academic Medical Centers
Age Factors
Aged, 80 and over
Aortic Aneurysm, Abdominal / mortality,  surgery*
Blood Vessel Prosthesis Implantation* / adverse effects,  mortality
Chi-Square Distribution
Feasibility Studies
Female
Humans
Kaplan-Meier Estimate
Male
Patient Selection
Philadelphia
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate
Time Factors
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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