Laparoscopic abdominal aortic aneurysm repair in octogenarians
Received 18 July 2008; accepted 3 December 2008. published online 23 March 2009.
Objective
Open abdominal aortic aneurysm (AAA) repair in octogenarians is considered to have higher risks of mortality and systemic complications compared with younger patients. The purpose of our work is to present our experience with total laparoscopic repair for AAA in this subset of patients.
Methods
From February 2002 to February 2008, 29 octogenarian patients underwent total laparoscopic AAA repair. Median age was 82 years (range, 80-85 years). Median aneurysm size was 52 mm (range, 40-85 mm). Disease was classified as American Society of Anesthesiologist (ASA) class II in 12 patients and class III in 17 patients. Ten patients presented with past medical history of myocardial infarct (34.5%).
Results
We implanted 12 tube grafts and 17 bifurcated grafts. Twenty-six procedures were totally laparoscopic (89.6 %). Median operative time and aortic clamping time were 280 min (range, 160-480 min) and 75 min (range, 22-125 min), respectively. Two patients with juxtarenal AAA underwent suprarenal clamping. Median blood loss was 1100 cc (range, 600-3000 cc). Four patients (13.8%) needed adjunctive vascular procedures because of intraoperative complications. Two patients died in the postoperative course (6.9%). Four patients developed severe systemic non-lethal complications (14.8%, pneumopathies). Mild or moderate systemic complications were observed in 14 patients (51.8%) including transient renal insufficiencies without dialysis (13) and cardiac arrhythmia (1). Postoperative creatinine levels returned to baseline before discharge in all patients. Liquid diet was reintroduced after a median duration of 2 days (range, 1-10 days) and most patients were ambulatory by day four (range, 3-30 days). Median stays in intensive care unit and hospital were 72 hours (range, 12-1368 hours) and 11 days (range, 6-74 days), respectively. Sixteen patients (59.2%) were discharged directly to home with complete recovery. After a median follow-up of 24 months (range, 2-48 months), 23 patients are still alive and regained their baseline status. Four patients died after hospital discharge of non-vascular etiologies.
Conclusion
Total laparoscopic AAA repair is a worthwhile but challenging procedure in octogenarians. Laparoscopy is complementary to open surgery and EVAR in this subset. These results encourage us to offer laparoscopic AAA repair in good surgical risk octogenarians.
aDepartment of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris, the Faculté de Médecine Paris-Ile de France-Ouest, Versailles Saint Quentin en Yvelines University, Boulogne-Billancourt, Paris
bDepartment of Anaesthesiology, Ambroise Paré University Hospital, Assistance Publique Hôpitaux de Paris, the Faculté de Médecine Paris-Ile de France-Ouest, Versailles Saint Quentin en Yvelines University, Boulogne-Billancourt, Paris
cDepartment of Vascular Surgery, Trousseau University Hospital, Tours, France
Reprint requests: Marc Coggia, MD, Department of Vascular Surgery, Ambroise Paré University Hospital, 9 Ave Charles de Gaulle, 92104 Boulogne Cedex, France
ABSTRACT