| Treatment of Elderly Patients
with Aneurysm of Abdominal Aorta |
(Department of Cardiovascular Surgery, Musashino
Red Cross Hospital, Tokyo, Japan)
| Hitoshi Fujiwara |
Takahiko Sugano |
Takeshi Someya |
|
Between December 1994 and December
2002, surgical repair of aneurysm of the abdominal aorta (AAA)
was performed in 139 patients, 32 of whom had ruptured AAA. Thirty-nine
patients were 80 years old or older (O) and 100 patients were
younger (Y) than 80. The ratio between ruptured and unruptured
AAA was significantly higher among older patientsiO: 41.0% versus
Y: 16.0%, p=0.002). Surgical mortality was identical in
those receiving elective repair (O: 0% versus Y: 0%) and similar
in those receiving repair following rupture (O: 13.3% versus
Y: 28.5%, p=0.314). A diagnosis of AAA had been made before
rupture in only 10 patients, whose survival rate was relatively
higher (100%) than that of patients without known AAA (66.7%).
Ten patients died of ruptured AAA without surgery. Four of them
had intractable cardiopulmonary arrest despite attempts at resuscitation.
Four other patients were debilitated due to other disease even
before rupture of AAA. Another 2 patients were diagnosed as ruptured
AAA at autopsy. In conclusion, elective surgical repair is safe
in elderly patients with AAA. The survival rate of elderly patients
following rupture of AAA is comparable to that of younger patients.
Some patients, however, should be excluded from aggressive treatment
because of associated conditions such as marked debilitation
prior to rupture or uncorrectable cardiopulmonary arrest on arrival.
Patient selection is a sensitive but important issue in the era
of society being composed of many elderly people.
@Jpn. J. Cardiovasc. Surg. 32: 337 -342 (2003) |
|
