Björn Sonesson1, Nuno Dias2, Tim Resch2. 1. Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden - b.sonesson@gmail.com. 2. Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden.
Abstract
INTRODUCTION: There is an increasing number of elderly in society and some of them may have an abdominal aortic aneurysm (AAA). The prevalence of AAA in octo- and nonagenarians indicates that this number could be substantial. The question is: is there an age limit for repair? This complex question incorporates ethical, political, economic and medical aspects. To answer part of this question a review of the outcome of elective and emergent AAA repair in those over 80 was done. EVIDENCE ACQUISITION: A literature research was done in the PubMed and Embase databases between 2007 and 2017 for either emergent and/or elective repair of AAA in individuals older than 80 years of age. EVIDENCE SYNTHESIS: Ten of 663 studies were found eligible for the review. Elective AAA repair in individuals more than 80 years shows a very varying outcome with 30-day mortality between 0% and 20.1% and 1-year mortality between 7% and 26%. Length of procedure, hospital stay, and number of major adverse events are also more in those over 80 years of age. In ruptured AAA 30-day mortality is between 29 and 59 % and 1 one year between 45% and 63%. CONCLUSIONS: No definitive answer whether to perform a repair of AAA in the elderly can be given. The decision has to be individualized and will also vary depending on ethical, political, economic factors and type of healthcare system the individual lives in.
INTRODUCTION: There is an increasing number of elderly in society and some of them may have an abdominal aortic aneurysm (AAA). The prevalence of AAA in octo- and nonagenarians indicates that this number could be substantial. The question is: is there an age limit for repair? This complex question incorporates ethical, political, economic and medical aspects. To answer part of this question a review of the outcome of elective and emergent AAA repair in those over 80 was done. EVIDENCE ACQUISITION: A literature research was done in the PubMed and Embase databases between 2007 and 2017 for either emergent and/or elective repair of AAA in individuals older than 80 years of age. EVIDENCE SYNTHESIS: Ten of 663 studies were found eligible for the review. Elective AAA repair in individuals more than 80 years shows a very varying outcome with 30-day mortality between 0% and 20.1% and 1-year mortality between 7% and 26%. Length of procedure, hospital stay, and number of major adverse events are also more in those over 80 years of age. In ruptured AAA 30-day mortality is between 29 and 59 % and 1 one year between 45% and 63%. CONCLUSIONS: No definitive answer whether to perform a repair of AAA in the elderly can be given. The decision has to be individualized and will also vary depending on ethical, political, economic factors and type of healthcare system the individual lives in.