Ruptured Abdominal Aortic Aneurysm in a Very Elderly Patient.
10.4326/jjcvs.26.51
- VernacularTitle:超高齢者破裂性腹部大動脈りゅうの１手術例
- Author:
Masahiro Yoshida
;
Hiroshi Kohnosu
;
Hayazou Kubo
;
Kazuhiro Yoshii
;
Nobuaki Shime
;
Shuji Shirakata
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
1997;26(1):51-54
- CountryJapan
- Language:Japanese
-
Abstract:
Surgical mortality associated with ruptured abdominal aneurysm remains high, especially in elderly patients, despite recent progress in improved patient management. We present the successful salvage of a 90-year-old woman with ruptured abdominal aortic aneurysm. She was transferred from another hospital because of severe abdominal and back pain and pulsatile abdominal tumor. One hour after admission, shock suddenly developed. We diagnosed her illness as ruptured abdominal aneurysm on enhanced CT scan. Emergency surgery was performed. The hematoma surrounding the aneurysm occupied the retroperitoneal space below the level of the diaphragm (Fitzgerald III). Aortic cross clamp was quickly performed below the level of the diaphragm approaching from the lesser omentum. After controlling bleeding, the site of the aortic cross clamping was changed to the infrarenal aorta. The aneurysm was resected and replaced by a knitted Dacron Y-graft (albumin coated). Duration of surgery was 5 hours and 5 minutes. Blood loss was 6200ml. After surgery, artificial ventilation was required for ten days to avoid hypoxemia. On the 5th postoperative day disseminated intravascular congulation (DIC) developed but she recovered. On the 30th postoperative day, she was discharged. Advanced age may not be an absolute contraindication for surgical treatment even in cases of rupture.
