Aneurisma aórtico abdominal en pacientes mayores de 80 años: tratamiento quirúrgico convencional en 80 casos consecutivos / Abdominal aortic aneurysms in patients over 80 years of age: conventional surgical treatment in 80 consecutive cases

BACKGROUND: Abdominal aortic aneurysms (AAA) may be lethal unless appropriately and timely treated. Since age is a surgical risk, octogenarians are usually not considered as candidates for surgical intervention. AIM: To asses surgical complications and mortality in octogenarians treated for AAA. SUBJECTS AND METHODS: Patients aged 80 years older, treated consecutively between 1984-2001 were retrospectively analyzed. RESULTS: Sixty one patients were male, and their age ranged from 80 to 95 years. All were treated with open surgery. The operation was elective in 58 and as an emergency in 22 patients (symptomatic or ruptured AAA). Aortic diameter was 6.8 +/- 1.4 cm in asymptomatic patients and 7.7 +/- 1.8 cm in emergency cases (p = 0.024). Thirty days postoperative mortality was 5.1% in elective surgery compared to 40.6% in emergency operations (p < 0.01). Five years survival rate was 44.7% in asymptomatic patients compared to 10.4% in the emergency cases (p < 0.023). CONCLUSIONS: Elective surgery for asymptomatic AAA can be performed with low operative mortality in octogenarians. However, surgery in emergency cases has an 8 fold increase in risk. Accordingly, octogenarian patients should be considered for elective AAA repair in a selective basis.

Frecuencia de aneurisma aórtico abdominal en población adulta con factores de riesgo conocidos / Frequency of abdominal aortic aneurysms in adult population with known risk factors

BACKGROUND: The incidence of abdominal aortic aneurysms has increased. Its predisposing factors are smoking, high blood pressure and dislipidemia. Progressive aneurysmal enlargement may lead to its rupture, which is associated to a mortality rate above 80 per cent. AIM: To assess the prevalence of abdominal aortic aneurysms in Chilean subjects with cardiovascular risk factors. SUBJECTS AND METHODS: Through announcements in open media we invited individuals aged over 60 years, who smoked, had hypertension and/or had occlusive arterial disease, to participate in a study that included medical history and physical examination. An aortic ultrasound was performed in all subjects in whom the aorta was not palpable or there was a suspicion of dilatation. Aortic diameter over 3 cm was considered aneurysmal. RESULTS: Three hundred fifty six subjects aged 67.1 +/- 6.7 years, (73.9 per cent males), were evaluated. The study group included 62 per cent hypertensives, 39 per cent with abnormal lipids and 46 per cent smokers. Known coronary heart disease or peripheral arterial diseases were present in 14 per cent and 10 per cent, respectively. Ultrasound was required in 159 subjects. Aneurysms were detected in 21 persons (5.9 per cent), 7.6 per cent in males and 1.1 per cent in females. The mean transverse diameter of the aneurysm was 4.1 cm (3-7.5). Aneurysm was found in 2.3 per cent of subjects younger than 65 years and 8.3 per cent of subjects aged over 65 years. CONCLUSIONS: In this sample the prevalence of abdominal aortic aneurysms was 5.9 per cent, affecting predominantly males, with a notorious increase with advanced age.

Tratamiento endovascular del aneurisma de aorta torácica descendente / Endovascular treatment of descending thoracic aorta aneurysm

BACKGROUND: The natural history of aneurysms ends in rupture and death. In 1990 the first endovascular exclusion of an aneurysm, using an endoluminal graft implanted through the femoral arteries was performed. More recently, the same procedure has been used for aneurysms of the thoracic aorta. AIM: To report our experience with endovascular treatment of thoracic aorta aneurysms. MATERIAL AND METHODS: Analysis of 14 patients (nine male), aged 30 to 79 years, treated between May 2001 and August 2002. RESULTS: The mean diameter of the aneurysms was 6.9 cm. The etiology was atherosclerotic in nine patients. The Excluder device (Gore) was preferentially used. There was no operative mortality or paraplegia. One patient had a transient leg monoparesis that reverted completely. No patient had type I endoleaks. Two patients had type II endoleaks on discharge, that sealed spontaneously. In a follow up, ranging from 2 to 17 months, one patient died of a bronchopneumonia and no aneurysm rupture has been detected. CONCLUSIONS: The short term results of endoluminal treatment of thoracic aorta aneurysms are excellent. This treatment is less invasive and has less complications than conventional surgery.