JoneFinlay38

Treatment of aortic aneurysms in older patients

Background

Treating abdominal aneurysms in elderly affected individuals, especially those aged around 80, has undergone a significant modification with the launch regarding aortic stent (EVAR). However some studies are in development regarding the advance associated with long lasting results with regard to “open” surgery treatment, it is obvious that the exemption of the aneurysm with a stent is far more acceptable in terms of the fast sufferer management, morbidity and fatality rate. In our institution we have obtained a significant increase in treating patients with aortic aneurysm treated with Endovascular aortic repair. We present data for the last two years 2009 and 2010.

Supplies as well as methods

In Cleveland Clinic, 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 “open” surgery) and 5 (11% ) in emergency (all in “open”). 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 “open” surgery) and 16 (16.6%) in urgency (two of these (12.5%) with EVAR and 14 (87.5%) treated with “open” surgery).

Results

The fatality rate in elective patients was 0.7% (1 patient underwent an endograft for abdominal aorta), while in emergency fatality was 18% (6 patients all operated in “open”). In one patient who underwent aor­tic stent there was an acute renal failure with long term dialysis. Cardiological problems were solved before discharge.

Conclusions

The treating of aneurysms of the thoracic as well as abdominal aorta has got advanced in terms of fatality and morbidity after the introduction of EVAR. In our experience, which tends to broaden the usage of aortic endoprosthesis, there are zero substantial differences in outcome between EVAR and “open” surgery. Older patients maintain better treatment method with the aortic stent graft.