Treatment of aneurysms of abdominal aorta in aged patients

Background

Treating aortic aneurysms in older people, especially those older around eighty, has undergone a significant transformation with the introduction of aortic stent (EVAR). Although some scientific studies are in progress regarding the improvement of long-term results with regard to �open� surgical procedure, there is no doubt that the particular exemption of the aneurysm with a stent is more relevant in terms of the instant patient administration, morbidity and death rate. In our association we have acquired an important increase in treating people with aortic aneurysm treated with EVAR. We present data for the last two years 2009 and 2010.

Supplies as well as methods

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 aneurysms of thoracic aorta (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 mortality rate in elective patients was 0.7% (1 patient underwent an endograft for abdominal aorta), while in emergency mortality was 18% (6 patients all operated in �open�). In one patient who experienced aor­tic stent there was an serious renal failure with long term dialysis. Cardiological problems were solved just before discharge.

Conclusions

The treating of aneurysms of the thoracic as well as abdom­inal aorta provides improved in terms of fatality and morbidity after the release of EVAR. In our experience, which tends to broaden the usage of aortic endoprosthesis, there are absolutely no significant differences in outcome between EVAR and �open� surgery. Older individuals sustain better remedy with the aortic stent graft.