title: Endovascular abdominal aortic aneurysm repair in nonagenarians--beyond limits?
abstract: Herein, we report a single institution's experience with endovascular abdominal aortic aneurysm repair in nonagenarians, over a 4-year period of time. We performed a retrospective study of cases, in which we documented patient demographics, symptoms, physical findings, surgical interventions, complications, and deaths. The survivors answered a questionnaire. Endovascular abdominal aneurysm repair was performed in 4 male nonagenarians (age range, 90-92 yr): 2 underwent repair of asymptomatic aneurysm and 2 underwent repair of symptomatic aneurysm. There was no in-hospital death, and patients were discharged after a median time of 11 days. Both patients with symptomatic abdominal aortic aneurysm died within 30 days, 1 of an occluded left femoral artery and the other of unknown cause. After follow-ups of 6 and 54 months, both survivors were in good physical condition and patient satisfaction appeared to be very high. We have shown that elective endovascular abdominal aneurysm repair in a small, selected group of nonagenarians was feasible and afforded acceptable short-term survival. In patients with symptomatic disease, however, the early postprocedural mortality rate appears to be high. Decision-making should focus chiefly on comorbidities, on subjective issues such as fear of rupture, and on ethical and financial considerations.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Alysis Zorggroep, Location Rijnstate, 6815 AD Arnhem, The Netherlands.
authors.forename: Marguerite F
authors.initials: MF
authors.lastname: Bouwmeester
authors.forename: Steven M M
authors.initials: SM
authors.lastname: van Sterkenburg
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: Willem R
authors.initials: WR
authors.lastname: de Vries
authors.forename: Michel M P J
authors.initials: MM
authors.lastname: Reijnen
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D017558:Elective Surgical Procedures; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D018579:Patient Selection; D013997:Time Factors; D016896:Treatment Outcome
references.citation: J Endovasc Ther. 2006 Jun;13(3):330-7
references.pmid: 16784320
references.citation: J Vasc Surg. 2008 May;47(5):924-7
references.pmid: 18358669
references.citation: J Endovasc Ther. 2008 Feb;15(1):1-11
references.pmid: 18254676
references.citation: J Vasc Surg. 2008 Mar;47(3):676-81
references.pmid: 18207352
references.citation: Ann N Y Acad Sci. 1996 Nov 18;800:1-24
references.pmid: 8958978
references.citation: J Vasc Nurs. 2008 Mar;26(1):15-21
references.pmid: 18295163
references.citation: Lancet. 2005 Jun 25-Jul 1;365(9478):2187-92
references.pmid: 15978926