Is 80 years too old for aneurysmectomy?

The records of 111 patients, 80 years of age or older, with a primary diagnosis of abdominal aortic aneurysm(AAA) showed that 86 patients underwent aneurysm resection and grafting. Ruptured AAAs (n=30) were associated with an operative mortality of 74%. By contrast, AAA resection in the expanding aneurysm group (n=19) and in the elective surgery group (n=44) was associated with a 10% and 2% mortality, respectively. Thus, resection of a nonruptured AAA in 63 octogenarians was carried out with an overall mortality of 4.7%. While nearly half of the patients had cardiac disease detected preoperatively, the elective group demonstrated a low incidence of previous myocardial infarction (7%) and congestive heart failure (8%). Concomitantly, the incidence of myocardial infarction (6%) and congestive heart failure was relatively low after AAA resection. Significant postoperative oliguric azotemia was observed in only 5% of the nonruptured patients. Long-term survival was comparable to that of the general population over the age of 80 years. The quality of life enjoyed by these patients was not adversely affected by AAA resection. By contrast, 50% of patients treated conservatively died of ruptured AAA. Physiologic rather than chronologic age should determine selection for AAA resection in the octogenarian.

Failure of ultralightweight knitted Dacron grafts in arterial reconstruction.

We have observed 11 cases in which the use of the ultralightweight knitted Dacron arterial graft made by the United States Catheter and Instrument Co. (USCI) was complicated by Interstitial hemorrhage dilation, or both. Although the incidence and specific cause of failure of this graft are unknown, we have discontinued its use on the basis of this experience.

Gastrointestinal hemorrhage from adhesion-related mesenteric varices.

As a result of this retrospective analysis of hemorrhage from a porta-systemic venous shunt occurring within the small intestine, we believe that the early diagnosis of the syndrome is strongly suggested by the presence of varices in unusual locations demonstrated by the venous phase of mesenteric arteriography. In all patients portal hypertension was present, and in all the affected bowel was adherent to postoperative adhesions on old suture lines. The syndrome was treated variously with lysis of adhesions, bowel resection, or portal-systemic shunt. Those patients with excellent hepatic reserve survived and had no further gastrointestinal bleeding.