Open abdominal aortic aneurysm repair is feasible and can be done with excellent results in octogenarians

Abstract

Objective: The purpose of this study was to determine the feasibility of open abdominal aortic aneurysm (AAA) repair in octogenarians during a time period of multiple commercially available endografts, in which only proximal aneurysms or the most challenging anatomy are not stented.

Methods: A retrospective review was performed of all patients aged ≥ 80 years undergoing open AAA repair over a 7-year period (2003-2009) at a single academic medical center. Demographic data, aneurysm characteristics, comorbidities, operative results, perioperative complications, length of stay, and late outcomes were analyzed.

Results: Sixty-five patients were identified (men, n = 27) with a median age of 82 years (80-89 years old). Mean aneurysm size was 6.7 cm. Morphology consisted of type IV thoracoabdominal (n = 19), suprarenal (n = 14), pararenal (n = 19), and infrarenal (n = 13). Eighty-five percent of cases were performed electively. A tube graft was used in 58 patients, and the left renal artery was bypassed in 33 patients. Fifty-two patients required a suprarenal or supraceliac clamp, with a mean proximal clamp time of 22 minutes. Mean estimated blood loss was 1800 mL. Mortality was 6% at 30 days. Overall morbidity was 42%, most commonly an arrhythmia (25%). Major complication rate was 18%. Median intensive care unit (ICU) and hospital length of stay was 3 and 9 days, respectively. Sixty-one percent of patients were discharged directly home. Six patients developed acute renal failure, although none progressed to dialysis. Mean serum creatinine was 1.3 mg/dL preoperatively and 1.5 mg/dL at discharge. One patient developed bowel necrosis (sigmoid colon) requiring resection. Follow-up ranged from 1 to 81 months (mean, 24 months). Three-year survival was 79%.

Conclusion: With an increasing population of elderly patients, vascular surgeons are continually confronted with patients over 80 years of age. Our patients consisted of those not anatomically suitable for endovascular aortic aneurysm repair. Despite a predominance of proximal aneurysms, our results demonstrate excellent rates of morbidity and mortality. Thus, open AAA repair can be done safely and effectively in octogenarians, and age alone should not exclude this form of repair.