Resumen de Tratamiento endovascular de aneurismas de aorta abdominal en octogenarios: 10 años de experiencia

C. Martínez Mira, Gonzalo Alonso Argüeso, Rafael Fernández Samos Gutiérrez, José Manuel Ortega Martín, Rubén Peña Cortés, Fernando Vaquero Morillo

• español

  Introducción El riesgo quirúrgico en pacientes añosos está incrementado por la comorbilidad asociada. A mayor edad, mayor es la prevalencia de aneurisma de aorta abdominal (AAA). Se analizan los resultados de morbimortalidad en la reparación endovascular del AAA (REVA) en pacientes octogenarios.

  Objetivos El análisis de los resultados del REVA.

  Material y métodos Del total de 244 pacientes programados, intervenidos de REVA entre enero 2000-diciembre 2009, se seleccionaron 53 con edad ≥ 80 años (3 mujeres-50 hombres). Edad media 83 ± 2,5 (80-89). Aneurismas asintomáticos 81%. Comorbilidad asociada: HTA 70%, tabaquismo 55%, cardiopatía 51%, insuficiencia renal 38%. ASA III-IV: 64%. Endoprótesis: 17 bifurcadas, 35 aortomonoiliacas, 1 recta. Exclusión de hipogástricas: 26. Estudio retrospectivo.

  Resultados Mortalidad a 30 días 3,7% (1 accidente cerebrovascular, 1 infarto agudo de miocardio [IAM]). Morbilidad perioperatoria (31%): 6 fracasos renales, 2 IAM, 3 claudicaciones glúteas. Estancia media 9 días. Seguimiento medio 23 ± 16,5 meses, 5 pacientes perdidos. Reintervenciones 2: 1 REVA por migración, 1 resección de injerto cruzado infectado. Fugas tipo II, 4. Supervivencia acumulada a 1-2-4 años 82, 70 y 24%, respectivamente. Mortalidad total 22 pacientes (46%).

  Conclusión La REVA ha mejorado los resultados del tratamiento del AAA en pacientes octogenarios, sin embargo, la mortalidad a medio plazo por causas no relacionadas con el REVA es elevada. Esto debe hacernos reflexionar sobre qué tipo de pacientes tratamos y su edad en el momento de la intervención, tanto en términos de balance riesgo quirúrgico/beneficio como en términos de asignación de recursos para un sistema médico económicamente viable.

• English

  Introduction Abdominal aortic aneurysm (AAA) is an age-related disease. Advanced age is also associated with comorbidities that increase surgical risks. We analyzed mortality and morbidity associated with endovascular aneurysm repair (EVAR) in octogenarians.

  Objective To analyse results of EVAR (Endovascular Aneurysm Repair).

  Methods A retrospective study of 244 patients who underwent EVAR from January 2000 to December 2009. A total of 53 patients aged ≥ 80 years were selected; 3 Women, 50 men. The mean age was age 83 ± 2.5 years (80-89), and 81% were asymptomatic. Comorbidities included: Hypertension 70%, Smoking 55%, cardiac disease 51%, renal disease 38%,and ASA III-IV 64%. 17 bifurcated grafts, 35 aortomonoiliac grafts and 1 straight graft were implanted. Twenty-six hypogastric arteries were excluded.

  Results The 30-day mortality was 3.7% (1 stroke- 1 MI), and the 30-day morbidity was 31%. There were, 6 renal function impairments, 2 MI, 3 buttock claudications. The mean postoperative stay was 9 days. The mean follow-up was 23 months (SD ± 16.5), in which 5 patients were lost. There were two reinterventions: one due to graft migration and another due to crossover bypass infection. There were 4 Type II endoleaks. The 1-2 and 4 year survival rates were 82%, 70% and 24%, respectively. The overall mortality was 46%.

  Conclusion EVAR has improved AAA treatment results in octogenarian patients. However, mid-term mortality is high for non-EVAR related causes. Therefore, we must consider the type of patient we treat and their age at the time of surgery, not only in terms of risk/benefit, but also in resource assignment to have a viable medical system.