Long-Term Results of Abdominal Aortic Aneurysm Repair for Patients Aged over 90 Years

(The Department of Thoracic and Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya, Japan)
Sukemasa Mukai Hideki Yao Takashi Miyamoto
Mitsuhiro Yamamura Hiroe Tanaka Takashi Nakagawa
Masaaki Ryomoto Yoshihito Inai
Of 225 patients who underwent surgery for abdominal aortic aneurysm from April 1995 to June 2002, 8 patients, or 3.6%, aged 90 years or more (mean age 90.8±1.4, range 90 to 94, 7 men and 1 woman) were the subjects of this study. Four of these patients (50%) underwent emergency surgery. Of these 4 patients, preoperative shock was found in 1 patient. Preoperative complications were hypertension in 4 (50%), ischemic heart disease in 1 (13%), disseminated intravascular coagulation syndrome in 1 (13%), and pleuritis in 1 (13%). The maximum diameter of AAA was 69.5±16.6mm (range 48 to 100mm). The surgical procedure was median laparotomy. Long-term follow-up by the attending physician, or questionnaire by phone was completed for all patients and range to 6.3 years (median, 2.4 years). There were no hospital deaths. Postoperative complications were delirium in 2 (25%), atelectasis in 1 (13%), and ileus in 1 (13%). There were 5 (63%) late deaths. The causes of death were pneumonia in 2, senescence in 1, cardiac failure in 1, and rupture of a pseudoaneurysm at the anastmotic site in 1. Long-term survivals at 1 year, 2 years, and 3 years were 88±12%, 63±17%, and 20±18%, respectively, whereas expected survivals at 1,2, and 3 years were 82%, 65%, and 51%, respectively. Long-term survivals were not good, but no significant difference was found between long-term and expected survivals. Therefore, this surgical and long-term treatment can achieve satisfactory results. This result led us to recommend performing the operation for patients aged 90 years or more, except if they were bedridden, had severe dementia, or were at the end stage of a malignant disease.
　Jpn. J. Cardiovasc. Surg. 32：206 -208（2003)