Abstract
We report successful endovascular aneurysm repair (EVAR) in an anatomically difficult case of abdominal aortic aneurysm (AAA) in a 92-year-old woman. An AAA of 30 mm in diameter was detected by computed tomography (CT) for gastric cancer in 2003. We decided to operate because her AAA enlarged to 55 mm in diameter in June 2009. Her medical history included gastrectomy for gastric cancer at 86 years old, an abdominal incisional hernia from 88 years old and chronic obstructive pulmonary disease and hypertension from 90 years old. The length of the normal aorta from the renal arteries to the aneurysm (proximal neck) was short (13 mm), and the terminal aorta was narrow (15 mm) and was severely calcified. We decided to perform EVAR with a Zenith® AAA endovascular graft because laparotomy posed a high risk for this oldest-old patient with severe respiratory dysfunction and a hostile abdomen. Stenosis of the left leg, poor dilatation at the junction of the right leg, and type 1 endoleak of the proximal neck were observed by postoperative CT scan. Under local anesthesia, she underwent re-touch up of the proximal neck with non-compliant balloon dilatation and touch up of the narrow site and junction. CT confirmed the improvement of the leg stent alignment and the disappearance of the type 1 endoleak. She has been free of complications for 1 year, and the size of the aneurysm has reduced to 41 mm in diameter. We successfully performed EVAR on an oldest-old patient with AAA. EVAR itself is a minimally-invasive procedure: however, the limit of EVAR indications must be ascertained. The present case was unique because of its application in an oldest-old patient.
