Treatment of aortic aneurysms in older patients

Background

The treating of abdominal aortic aneurysms in aged patients, specifically those older around 80, has undergone a significant modify with the launch of aortic stent (EVAR). However some scientific tests are in development regarding the advance associated with long lasting results with regard to “open” surgery, there is no doubt that the actual exemption of the aneurysm with a stent is much more relevant in terms of the immediate sufferer management, morbidity and fatality rate. In our establishment we have had a significant increase in the treating patients with aortic aneurysm treated with Endovascular aortic repair. We present data for the last two years 2009 and 2010.

Materials and solutions

Inside 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 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 death 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 lasting dialysis. Cardiological problems were resolved just before discharge.

Conclusions

The treatment of aneurysms of the thoracic along with abdom­inal aorta has got advanced in terms of fatality rate and morbidity after the arrival of EVAR. In our experience, which tends to grow the usage of aortic endoprosthesis, there are certainly no substantive differences in outcome among EVAR and “open” surgery. Older individuals maintain better treatment with the aortic stent graft.