THE PLACE OF A SURGICAL-TREATMENT OF ABDO MINAL AORTIC-ANEURYSMS IN 80 YEAR-OLD PATIENTS

Whether or not to operate an asymptomatic aneurysm of the aorta in a p atient over 80 years of age is a question increasingly facing the surg eon: longer life span (about 7 years), aneurysm discovered on a sonogr am or scan ordered for digestive, urologic or pelvic disorders. This d iscussion is based on a personal retrospective series of 800 patients who underwent elective operation for non-ruptured aneurysms of the sub renal abdominal aorta between January 1985 and June 1990. For the 732 patients under 80, mortality was 1.9 % and for the 68 patients over 80 , it was 8.8 %, emphasising that in this group survival at 6 months wa s reduced by 10 %. The operative risk, as for younger subjects, result s from coronary risk (reversible ischaemia), the quality of the heart muscle (ejection fraction < 35 %), respiratory and renal function. Inc reased age raises mortality when one of these factors is severely jeap ordized but associated lesions, such as digestive disorders or arteria l lesions (severe occlusion of the downstream vessels, occlusion of th e mesenteric and hypogastric arteries increases the risk of acute isch aemia of a limb or the intestine), should also be taken into considera tion.Indications for operation should be discussed in light of these f actors in patients at risk (large aneurysm > 60 mm or increasing in si ze, ''images'', suggesting. risk of rupture : bleb or bubble ectasia, flotting mural thrombus, ''digitiform'' lysis of a mural thrombus, rup ture of the calcified shell or covered rupture). When there is a high risk of lesion and the operative risk prohibits conventional surgery, other procedures can be discussed: axillo-bifemoral bypass with exclus ion of the iliac and secondary embolization or subrenal exclusion, sub stitution with an endo-aortic prosthesis allowing wider indications.