OPERATIVE TREATMENT OF ABDOMINAL AORTIC-ANEURYSMS IN OCTOGENARIANS - WHEN IS IT TOO MUCH TOO LATE

Objective This study evaluated the value of operation for treatment of all octogenarians with ruptured abdominal aortic aneurysms (AAA). Sum mary Background Data Elective AAA resection in octogenarians is safe, with published operative mortality rates of approximately 5%. Publishe d operative mortality rates of ruptured AAA in this age group, however , vary from 27 to 92%. Methods To evaluate this question, we extracted the clinical course of the 34 octogenarians submitted to AAA resectio n by the authors from our total experience of 548 resections performed during the past 7 1/2 years. In this subgroup of octogenarians, 18 un derwent elective AAA replacement, 5 were submitted to urgent resection of active but intact AAAs, and 11 had operations for ruptured AAAs. T here were 23 males and 11 females in the group. The ages ranged from 8 0 to 91 years. Results Operative mortality in the patients managed ele ctively was 5.6%. Two of the five patients (40%) submitted to operatio n for active yet unruptured aneurysms died in the preoperative period. Finally, 10 of the 11 patients (91%) with ruptured AAAs were operativ e mortalities. All of these operative mortalities in the ruptured AAA subgroup had severe hypotension preoperatively (mean systolic blood pr essure: 23 mm Hg), The charges associated with the management of the r uptured AAA group averaged $84,486 (range $12,537-$199,233). Conclusio ns Although elective replacement of AAA in properly selected octogenar ians appears valuable to prolong worthwhile life expectancy, this expe rience leads us to consider observation only in the treatment of octog enarians with ruptured AAA who present with severe hemodynamic instabi lity.