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November 1976

Is 80 Years Too Old For Aneurysmectomy?

Author Affiliations

From the Department of Surgery (Drs O'Donnell, Darling, and Linton), Harvard Medical School at the Massachusetts General Hospital, Boston. Dr O'Donnell is now with the Department of Surgery, Tufts University School of Medicine, Medford, Mass.

Arch Surg. 1976;111(11):1250-1257. doi:10.1001/archsurg.1976.01360290084012

• The records of 111 patients, 80 years of age or older, with a primary diagnosis of abdominal aortic aneurysm (AAA) showed that 86 patients underwent aneurysm resection and grafting. Ruptured AAAs (n = 30) were associated with an operative mortality of 74%. By contrast, AAA resection in the expanding aneurysm group (n = 19) and in the elective surgery group (n = 44) was associated with a 10% and 2% mortality, respectively. Thus, resection of a nonruptured AAA in 63 octogenarians was carried out with an overall mortality of 4.7%. While nearly half of the patients had cardiac disease detected preoperatively, the elective group demonstrated a low incidence of previous myocardial infarction (7%) and congestive heart failure (8%). Concomitantly, the incidence of myocardial infarction (6%) and congestive heart failure was relatively low after AAA resection. Significant postoperative oliguric azotemia was observed in only 5% of the nonruptured patients. Long-term survival was comparable to that of the general population over the age of 80 years. The quality of life enjoyed by these patients was not adversely affected by AAA resection. By contrast, 50% of patients treated conservatively died of ruptured AAA. Physiologic rather than chronologic age should determine selection for AAA resection in the octogenarian.

(Arch Surg 111:1250-1257, 1976)

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