Document Detail


Treatment of abdominal aortic aneurysm disease in the 9th and 10th decades of life.
MedLine Citation:
PMID:  9322704     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The appropriate management of patients who are older than 80 years of age and who present with an abdominal aortic aneurysm (AAA) remains controversial. While it appears that elective repair can be performed safely, appropriate management of these patients in the emergency situation is unclear. The purpose of the present study was to examine the results obtained in treating this elderly group in the elective and emergency setting, by operation and conservative techniques at St George Hospital, Kogarah. METHODS: Between January 1987 and December 1994 85 patients older than 80 years of age were treated for AAA. These patients were divided into four groups: I, elective presentation/no surgery; II, elective presentation/elective surgical repair; III, emergency presentation/surgical repair; and IV, emergency presentation/conservative treatment. We examined age, sex, size of AAA, mode of presentation, type of treatment, length of survival and cause of death. RESULTS: The mean age of the total group (n = 85) of patients was 84 years (range: 80-94). The mean AAA diameter for this group was 5.6 cm (95% CI: 5.2-6 cm). The diameters for group I (n = 40), II (n = 22), III (n = 16) and IV (n = 7) were 4.9 cm (4.4-5.5, 95% CI), 5.7 (4.9-6.5 CI), 7.0 (6.1-7.7 CI) and 6.2 (5.2-7.2 CI), respectively. The median survival for groups I, II, III and IV was 18, 38.5, 0.25 and 0 months, respectively. Group II had a longer survival than any other group (P = 0.015), and group IV had a shorter survival than the total group (P = 0.001). However, the length of survival was no different for III versus IV (P = 0.146). Deaths in each group were due to the following reasons. I: cardiopulmonary events (14), rupture (3), malignancy/sepsis (3); II: cardiopulmonary events (3), rupture (thoracic aneurysm) (2), malignancy (I); III: rupture (10), malignancy (I); and (IV): rupture (6), malignancy (1). CONCLUSIONS: Elective surgical repair offers the best management option for AAA in patients older than 80 years of age. Death may still occur from progression of aneurysmal disease at other sites. An aggressive surgical approach to the management of haemodynamically unstable patients in this age group is of questionable benefit.
Authors:
D Robinson; R Englund; K C Hanel
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Australian and New Zealand journal of surgery     Volume:  67     ISSN:  0004-8682     ISO Abbreviation:  Aust N Z J Surg     Publication Date:  1997 Sep 
Date Detail:
Created Date:  1997-10-23     Completed Date:  1997-10-23     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0373115     Medline TA:  Aust N Z J Surg     Country:  AUSTRALIA    
Other Details:
Languages:  eng     Pagination:  640-2     Citation Subset:  IM    
Affiliation:
Department of Vascular Surgery, St George Hospital, Kogarah, New South Wales, Australia.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over*
Aortic Aneurysm, Abdominal / mortality,  surgery*
Cause of Death
Emergencies
Female
Follow-Up Studies
Humans
Male
Patient Selection*
Surgical Procedures, Elective
Survival Analysis
Treatment Outcome

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


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