title: Reconstructive surgery for carotid artery occlusive disease in the elderly--a high risk operation?
abstract: Patients over 80 yr of age may require carotid surgery for symptomatic or critical asymptomatic carotid artery occlusive disease.A total of 2262 operations were performed between 1990 and 1999; 76 (3.4%) were carotid reconstructions in 70 patients over 80 yr of age. Twenty patients (26%) presented with asymptomatic critical stenosis. Transient ischemic symptoms were the reason for presentation in 35 patients (46%). Progressive stroke was documented in two patients (3%) and a stroke with persisting neurological deficit was demonstrated in 19 cases (25%). Coronary artery disease was present in 47 patients (38%) and arterial hypertension in 55 (72%). Fifty-nine patients (84%) were classified as ASA group 3. Seventy-one thromboendarterectomies of the carotid bifurcation with vein-patch closure were performed. Five patients had other types of reconstruction. Simultaneous operations (aorto-coronary vein-bypass, aortic interposition graft etc.) were performed in nine patients. Postoperative complications occurred in three patients. One had a transient neurological deficit and another a lethal stroke; the third patient died from myocardial infarction. The in-hospital mortality was 2.9%, which was not significantly higher than the results of the other 2186 reconstructions (1.5%). Surgery for carotid artery occlusive disease can be safely performed in selected patients of more than 80 yr of age.
authors.affiliation: Heinrich-Heine-University Duesseldorf, Department for Vascular Surgery and Kidney Transplantation, Moorenstrasse 5, 40225 Düsseldorf, Germany. andreas.ommer@uni-duesseldorf.de
authors.forename: A
authors.initials: A
authors.lastname: Ommer
authors.forename: M
authors.initials: M
authors.lastname: Pillny
authors.forename: K
authors.initials: K
authors.lastname: Grabitz
authors.forename: W
authors.initials: W
authors.lastname: Sandmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D000075202:Contraindications; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment