Treatment of abdominal aneurysms in elderly patients

Background

The treatment of abdominal aortic aneurysms in older affected individuals, specifically those aged around 80, has undergone a significant transform with the release of aortic stent (EVAR). However some scientific tests are in development regarding the improvement of long lasting results with regard to âopenâ surgical treatments, it is evident that the exclusion of the aneurysm with a stent is more acceptable in terms of the immediate patient management, morbidity and death rate. In our association we have possessed a significant increase in treating sufferers with aortic aneurysm treated with Endovascular AAA repair. We present data for the last two years 2009 and 2010.

Supplies and techniques

Inside Cleveland Centre, from January 2009 to November 2010, 168 aneurysms of the thoracic and abdominal aorta were treated, of which 135 were elective and 33 emergency. Of these 39 % were patients over 75 years of age. In 2009 we operated 52 patients of whom 7 (13:45%) for thoracic aortic aneurysm and 45 (86.55%) for aneurysms of the abdominal aorta. 6 thoracic aortic aneurysms (86%) were operated on electively and 1 (14%) urgently, all with a stent implant. 40 aneurysms of the abdominal aorta (89%) were operated on electively (of these 25 (62.5%) with EVAR and 15 (37.5%) with âopenâ surgery) and 5 (11% ) in emergency (all in âopenâ). In 2010, 116 patients were treated, of which 20 (17.3%) had an aneurysm of the thoracic aorta and 96 (83.4) an aneurysm of the abdominal aorta. 14 aneurysms of the thoracic aorta (70%) were operated on electively and 6 in emergency (30%), all with EVAR. 80 aneurysms of the abdominal aorta (83.3%) were operated on electively (of these 70 (87.5%) with EVAR and 10 (12.5%) treated with âopenâ surgery) and 16 (16.6%) in urgency (two of these (12.5%) with EVAR and 14 (87.5%) treated with âopenâ surgery).

Results

The mortality rate in elective patients was 0.7% (1 patient underwent an endograft for abdominal aorta), while in emergency fatality rate was 18% (6 patients all operated in âopenâ). In one patient who undergo aorÂ­tic stent there was an acute renal failure with long lasting dialysis. Cardiological issues were resolved ahead of discharge.

Conclusions

The treatment of aneurysms of the thoracic along with abdomÂ­inal aorta has got upgraded in terms of mortality and morbidity after the arrival of EVAR. In our experience, which tends to increase the effective use of aortic endoprosthesis, there are certainly no substantive differences in outcome between EVAR and âopenâ surgery. Elderly sufferers sustain much better treatment with the aortic stent graft.