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Article
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
Abstract

• 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)

References
1.
Darling RC:  Ruptured arteriosclerotic abdominal aortic aneurysms: A pathologic and clinical study .  Am J Surg 119:397-401, 1970.Crossref
2.
Hicks GL, Eastland MW, DeWeese JA, et al:  Survival improvement following aortic aneurysm resection .  Ann Surg 181:863-869, 1975.Crossref
3.
Thompson JE, Hollier LH, Patman RD, et al:  Surgical management of abdominal aortic aneurysms: Factors influencing mortality and morbidity—A 20 year experience .  Ann Surg 181:654-661, 1975.Crossref
4.
DeWeese JA, Blaisdell FW, Foster JH:  Optimal resources for vascular surgery .  Circulation 46:305-324, 1972.
5.
Ottinger LW:  Ruptured arterial sclerotic aneurysms of the abdominal aorta: Reducing mortality .  JAMA 233:147-150, 1975.Crossref
6.
Szilagyi DE, Smith RF, DeRusso FJ, et al:  Contribution of abdominal aortic aneurysmectomy to prolongation of life .  Ann Surg 164:678-699, 1966.Crossref
7.
Crane C:  Arteriosclerotic aneurysm of the abdominal aorta: Some pathological and clinical correlations .  N Engl J Med 253:954-958, 1955.Crossref
8.
Schatz IJ:  Treatment of unruptured abdominal aortic aneurysms .  JAMA 213:629, 1970.Crossref
9.
Edmunds LH Jr:  Resection of abdominal aortic aneurysms in octogenarians .  Ann Surg 165:453-457, 1967.Crossref
10.
Cutler SJ, Ederer F:  Maximum utilization of a life table method in analyzing survival .  J Chronic Dis 8:699-704, 1958.Crossref
11.
 Vital Statistics of the United States Mortality Analysis and Summary US Department of Health, Education and Welfare, 1960, vol 2 pp 1-21.
12.
DeBakey ME, Crawford ES, Cooley DA, et al:  Aneurysm of abdominal aorta: Analysis of results of graft replacement therapy 1 to 11 years after operation .  Ann Surg 160:622-639, 1964.Crossref
13.
 Annual Report of Vital Statistics . Boston, Commonwealth of Massachusetts Public Health, Office of Health Planning and Statistics, 1974.
14.
Fette CW, Hobson RW, Rich NM:  Surgical management of 100 consecutive abdominal aortic aneurysms .  Am J Surg 129:506-508, 1975.Crossref
15.
Stokes J, Butcher HR Jr:  Abdominal aortic aneurysms. Factors influencing operative mortality and criteria of operability .  Arch Surg 107:297-302, 1973.Crossref
16.
Szilagyi DE, Eliott JP, Smith RF:  Clinical fate of the patient with asymptomatic abdominal aortic aneurysm and unfit for surgical treatment .  Arch Surg 104:600-606, 1972.Crossref
17.
Baker WH, Munns JR:  Aneurysmectomy in the aged .  Arch Surg 110:513-517, 1975.Crossref
18.
Esselstyn CB Jr, Humphries AW, Young JR, et al:  Aneurysmectomy in the aged?  Surgery 67:34-39, 1970.
19.
Linton RR:  Atlas of Vascular Surgery . Philadelphia, WB Saunders Co, 1973, pp 266-269.
20.
Klippel AP, Butcher HR Jr:  The unoperated abdominal aortic aneurysm .  Am J Surg 111:629-631, 1966.Crossref
21.
Schatz IJ, Fairbairn NF, Juergens JL:  Abdominal aortic aneurysms: A reappraisal .  Circulation 26:200-205, 1962.Crossref
22.
Steinberg I, Stein HL:  Arteriosclerotic abdominal aneurysms: Report of 200 consecutive cases diagnosed by intravenous aortography .  JAMA 195:1025-1029, 1966.Crossref
23.
Szilagyi DE, Eliott JP, Smith RF:  Clinical fate of the patient with asymptomatic abdominal aortic aneurysm and unfit for surgical treatment .  Arch Surg 104:600-606, 1972.Crossref
24.
Baker AG Jr, Roberts B:  Long-term survival following abdominal aortic aneurysmectomy .  JAMA 212:445-450, 1970.Crossref
25.
Volpetti G, Barker CF, Berkowitz H, et al:  A 22 year review of elective resection of abdominal aortic aneurysms .  Surg Gynecol Obstet 142:321-324, 1976.
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