LETTER
Aortic Aneurysm in Elderly Patients
Barbara E. Cammer Paris, MD, and
Christine Cassel, MD
15 July 1998 | Volume 129 Issue 2 | Page 166
TO THE EDITOR:
We read Dr. Fiebach's article [1] with a great sense of familiarity. As primary care geriatricians in a multispecialty outpatient practice (average age of patients, 83 years), weighing the risks and benefits of procedures in patients like Dr. S is part of our expertise and daily experience. We were, therefore, particularly surprised by the statement that the gerontologist with whom the author consulted "offered only that his approach was not to look for abdominal aneurysms in octogenarians."
Abdominal aortic aneurysm (AAA) is, for the most part, a disease of the elderly. Elective surgery can improve survival in asymptomatic patients, Dr. S's life expectancy at age 87, the time of discovery of his aneurysm by Dr. Fiebach, was 5 years. His risk for rupture was clearly worrisome as the growth of his aneurysm exceeded the expected expansion rate of 0.5 cm per year [2]. Although the overall mortality rate associated with AAA rupture is 80% to 90%, operative mortality rates for intact AAA repair have declined from 13.6% in 1980 to 5.6% in 1990 [3]. Furthermore, newer procedures, including endoluminal stent-grafts, are emerging as a viable alternative to major abdominal surgery [4].
Dr. Fiebach's approach to his patient is commendable. The response he received from the gerontologist is not consistent with the current state of the art in geriatric medicine's approach to patient care. With continual improvements in both anesthesia and surgical expertise, surgery can no longer be denied to patients solely on the basis of age [5].
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Author and Article Information
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Mount Sinai Medical Center; New York, NY 10029
1. Fiebach NH. Rise and fall. Ann Intern Med. 1997; 127:1037-8.
2. Vander der Vliet JA, Boll AP. Abdominal aortic aneurysm. Lancet. 1997; 349:863-6.[Medline]
3. Katz DJ, Stanley JC, Zelenock GB. Operative mortality rates for intact and ruptured abdominal aortic aneurysms in Michigan: an eleven-year statewide experience. J Vasc Surg. 1994; 19:804-17.
4. Blum U, Gotz V, Lammer J, Beyersdorf F, Tollner D, Kretschmer G, et al. Endoluminal stent-grafts for infrarenal abdominal aortic aneurysms. N Engl J Med. 1997; 336:13-20.
5. Thomas DR, Ritchie CS. Preoperative assessment of older adults. J Am Geriatr Soc. 1995; 43:811-21.
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