TREATMENT OF ABDOMINAL AORTIC-ANEURYSM DISEASE IN THE 9TH AND 10TH DECADES OF LIFE

Background: The appropriate management of patients who are older than 80 years of age and who present with an abdominal aortic aneurysm (AAA ) remains controversial. While it appears that elective repair can be performed safely, appropriate management of these patients in the emer gency situation is unclear. The purpose of the present study was to ex amine the results obtained in treating this elderly group in the elect ive and emergency setting, by operation and conservative techniques at St George Hospital, Kogarah. Methods: Between January 1987 and Decemb er 1994 85 patients older than 80 years of age were treated for AAA. T hese patients were divided into four groups: I, elective presentation/ no surgery; II, elective presentation/elective surgical repair; III, e mergency presentation/surgical repair; and IV, emergency presentation/ conservative treatment. We examined age, sex, size of AAA, mode of pre sentation, type of treatment, length of survival and cause of death. R esults: The mean age of the total group (n = 85) of patients was 84 ye ars (range: 80-94), The mean AAA diameter for this group was 5.6 cm (9 5% CI: 5.2-6 cm). The diameters for group I (n = 40), II (n = 22), III (n = 16) and IV (n = 7) were 4.9 cm (4.4-5.5, 95% CI), 5.7 (4.9-6.5 C I), 7.0 (6.1-7.7 CI) and 6.2 (5.2-7.2 CI), respectively. The median su rvival for groups I, II, III and IV was 18, 38.5, 0.25 and 0 months, r espectively. Group II had a longer survival than any other group (P = 0.015), and group IV had a shorter survival than the total group (P = 0.001). However, the length of survival was no different for III versu s IV (P = 0.146). Deaths in each group were due to the following reaso ns. I: cardiopulmonary events (14), rupture (3), malignancy/sepsis (3) ; II: cardiopulmonary events (3), rupture (thoracic aneurysm) (2), mal ignancy (1); III: rupture (10), malignancy (I); and (IV): rupture (6), malignancy (1). Conclusions: Elective surgical repair offers the best management option for AAA in patients older than 80 years of age. Dea th may still occur from progression of aneurysmal disease at other sit es. An aggressive surgical approach to the management of haemodynamica lly unstable patients in this age group is of questionable benefit.