Carotid endarterectomy in the octogenarian.
During a 10-year period from January 1983 to December 1992, 79 carotid endarterectomies were performed in patients aged 80 years or older. This represented 7.4% of the total patient population undergoing carotid endarterectomy at Emory University Hospital. The indications for surgery in this elderly population were transient ischemic attacks in 24 (30.3%), cerebrovascular accident in 12 (15.2%), amaurosis fugax in seven (8.9%), vascular tinnitus in one (1.3%), and asymptomatic stenosis in 35 (44.3%). The average degree of ipsilateral stenosis was 76.8%. Concomitant risk factors included coronary artery disease in 43%, systemic arterial hypertension in 51.9%, diabetes mellitus in 10.1%, and significant smoking history in 53.2%. Seventy-six percent of the procedures were performed under local anesthesia, and in all but two intraluminal shunts were used. Combined 30-day mortality and postoperative stroke morbidity in this population was 1.3% (one patient). Long-term follow-up ranging from 1 to 10 years (average 35 months) revealed no ipsilateral strokes. This experience suggests that carotid endarterectomy can be performed in an elderly population with morbidity and mortality rates similar to those in a younger cohort.
Coyle
K A
KA
Department of Surgery, Emory University School of Medicine, Atlanta, Ga 30322.
Smith
R B
RB
Salam
A A
AA
Dodson
T F
TF
Chaikof
E L
EL
Lumsden
A B
AB
D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors