A limited and customized follow-up seems justified after endovascular abdominal aneurysm repair in octogenarians

ObjectiveThe objective of this study was to determine whether long-term follow-up after endovascular aneurysm repair (EVAR) is justified in octogenarians.MethodsBetween September 1996 and October 2011, all patients, including octogenarians, treated for an abdominal aortic aneurysm (AAA) by EVAR were included in a prospective database. Patients older than 80 years and with a nonruptured infrarenal aneurysm treated electively or urgently were included in the study (study group [SG]). Patients with ruptured aneurysms and patients who died during surgery or within the first postoperative month were excluded from further analysis. The control group (CG) consisted of patients younger than 80 years, matched for gender and AAA diameter. All patients were evaluated 4 to 8 weeks after EVAR and then annually thereafter. Follow-up data were complemented by review of the computerized hospital registry and charts and by contact of the patient's general practitioner or referring hospital. Primary outcomes were stent- or aneurysm-related complications and interventions. Secondary outcomes were additional surgical complications and patient survival.ResultsA total number of 193 patients (SG, n = 97; CG, n = 96) were included for analysis. Median age was 80 years, and 88.6% were male. Median follow-up time was 33.6 months (interquartile range [IQR], 12.9-68.3). Stent- and procedure-related postoperative complications were comparable between groups (SG, 41.2%; CG, 39.6%; P = .82). Median time to complication was 2.3 months (IQR, 0.2-19.4) in the SG compared with 18.1 months (IQR, 6.8-50.5) in the CG. The 2-year complication-free survival rates were 58% (SG) and 60% (CG). Interventions were performed significantly less frequently in octogenarians (SG, 8.2%; CG, 19.8%; P < .05). Median time to intervention was 11.1 months (IQR, 2.0-31.0) in the SG compared with 54.3 months (IQR, 15.0-93.2) in the CG. The 2-year intervention-free survival rates were 90% (SG) and 92% (CG). During follow-up, 98 patients died (SG, n = 54; CG, n = 44); median time to death was 31.8 months (IQR, 13.3-66.0) in the SG compared with 44.4 months (IQR, 15.0-77.7) in the CG. One aneurysm-related death occurred in the CG. The 2- and 5-year survival rates were 71% and 32% for the SG compared with 77% and 66% for the CG (P < .05).ConclusionsBecause of the low incidence of secondary procedures and AAA-related deaths in octogenarians, long-term and frequent follow-up after EVAR seems questionable. An adapted and shortened follow-up seems warranted in this patient group

Elective surgery of abdominal aortic aneurysms in octogenarians: a systematic review

Abdominal aortic aneurysm (AAA) is an age-related disease. In an aging population, the prevalence of AAA is likely to increase. Open AAA repair in patients aged >80 years is often not considered because of their advanced age as such or because of comorbidities. In addition, little is known about the natural history in such patients or survival after successful repair. We performed a systematic review of the literature to determine peri-operative and late survival after AAA repair in octogenarians The Medline, Embase, and Cochrane databases were searched to identify all studies reporting on octogenarians undergoing AAA repair published between January 1966 and June 2006. Two independent observers assessed the methodologic quality of the included studies and the data extraction. Outcomes were rates of perioperative mortality, complications, and long-term survival after open or endovascular repair (EVAR). Summary estimates with 95% confidence interval (CI) were calculated using a random effects model. Thirty-nine articles were included. The median aneurysm size was 6.7 cm in the conventional AAA repair group of 1534 patients. The perioperative mortality was 0% to 33%, with a pooled mortality of 7.5% (95% CI, 6.2% to 9.0%). The median 5-year survival rate for this group was 60% (range, 14% to 86%). In the 1045 patients treated with EVAR, the median aneurysm size was 5.9 cm. Their pooled perioperative mortality varied from 0% to 6%, with a pooled mortality of 4.6% (95% CI, 3.4 to 6.0%). We could not derive 5-year survival rates from articles describing endovascular repair of AAA. The mortality rate after open or endovascular AAA repair in carefully selected octogenarians seems acceptable but is higher than the mortality rate in younger patients. Long-term survival rates were acceptable, but small sample size, selection, and publication bias must be taken into account. Finally, selection criteria for successful surgery with low mortality and morbidity rates cannot be derived from the literatur

Diagnostiek en behandeling bij 'body-packer'-syndroom

A body packer is someone who carries drugs such as heroine or cocaine, packed in rubber or plastic, in his/her body in order to smuggle them. These people can present with symptoms that vary from mild abdominal complaints to respiratory insufficiency and even death. Physical examination and additional radiology tests are helpful for the diagnosis. Any packages can usually be seen on a plain abdominal X-ray. Detailed information on the number of drug packages, their exact location in the gastrointestinal tract and complications, such as small intestine obstruction or perforation, can be derived from a CT scan. In most patients conservative treatment suffices. Surgery for body packing, i.e. the removal of the packages by gastrotomy or enterotomy, is often followed by serious complications related to contamination of the peritoneum that frequently occur