Abstract
Due to progress in medicine, surgery for abdominal aortic aneurysm (AAA) can yield a safe and reliable outcome; however, the results of surgery of a ruptured aneurysm, or those in very elderly patients are still poor, and no standardized therapeutic strategies have been established. In the present study, the clinical course and therapeutic outcome of ruptured abdominal aortic and iliac aneurysms (RAAA) for patients aged 80 years or over at our hospital were evaluated. A total of 56 patients were brought to our hospital with RAAA between June 2001 and November 2008; and, excluding 14 who succumbed before surgery, 42 surgical cases were enrolled in the study. The patients were divided into group E (20 patients, 80 years or older) and group Y (22 patients, 79 or younger). The two groups were compared according to the various factors: Preoperative factors included co-existent diseases, aneurysmal diameter, Hardman factor (HF), time elapsed between the onset of the disease and arrival at the hospital and between arrival and surgery. Intraoperative factors included time required for surgery, time elapsed before aortic champing, duration of aortic clamping, amount of blood loss, amount of blood transfused, Szilagyi classification and surgical procedures. The postoperative factors were the length of hospitalization, complications and mortality. The mean ages in groups E and Y were 84 and 64 years. Replacement with artofemoral vessels was the basic surgical procedure in both groups. The surgical outcome was summarized as follows: intraoperative mortality, 0 in both E and Y groups: mortality immediately after surgery, 4 and 3; and in-hospital mortality after surgery, 5 and 5. Mortality following hospital admission (including those 9 E cases and 5 Y cases who died before surgery) was 14 and 10. No differences were noted in mortality or duration of hospitalization between these 2 groups. However, significant differences were noted in hemorrhage-related factors when those who survived the procedure were compared with those who did not. Moreover, a successful surgical outcome was noted in those patients who were able to survive shock with the aid of fluid infusions. We were convinced that the surgical outcome in RAAA is generally satisfactory at our hospital; and even in very elderly patients, surgical results and postoperative QOL similar to those in younger patients can be expected.
