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| CASE REPORT |
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| Year : 2021 | Volume
: 8
| Issue : 4 | Page : 373-374 |
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A case of successful thoracic endovascular aneurysm repair in a 106-year-old female
Kanako Kobayashi1, Ayaka Yu2, Naoki Fujimura2, Satoshi Otsubo1
1 Department of Cardiovascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
2 Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo, Japan
| Date of Submission | 21-Jul-2021 |
| Date of Decision | 27-Jul-2021 |
| Date of Acceptance | 29-Jul-2021 |
| Date of Web Publication | 9-Dec-2021 |
Correspondence Address:
Naoki Fujimura
Department of Vascular Surgery, Saiseikai Central Hospital, Tokyo
Japan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijves.ijves_82_21
As the population ages, the average age of patients is expected to rise. Here, we describe a successful case of thoracic endovascular aneurysm repair (TEVAR) performed in a 106-year-old female. The patient had an impending rupture of 6 cm saccular aneurysm at the descending thoracic aorta. Although the patient was super senile, her activity of daily living was independent. After multiple multidisciplinary conference and informed consent, TEVAR using local and venous anesthesia was successfully performed. This case illustrates the importance of strict examination of each case for treatment indications, including risk/benefit balance, in a super aging world.
Keywords: Centenarian, super elderly, thoracic endovascular aneurysm repair
How to cite this article:
Kobayashi K, Yu A, Fujimura N, Otsubo S. A case of successful thoracic endovascular aneurysm repair in a 106-year-old female. Indian J Vasc Endovasc Surg 2021;8:373-4 |
How to cite this URL:
Kobayashi K, Yu A, Fujimura N, Otsubo S. A case of successful thoracic endovascular aneurysm repair in a 106-year-old female. Indian J Vasc Endovasc Surg [serial online] 2021 [cited 2022 Jan 25];8:373-4. Available from: https://www.indjvascsurg.org/text.asp?2021/8/4/373/332059 |
| Introduction | |  |
By 2050, the number of people aged ≥80 years is projected to triple.[1] In Japan, the proportion of those aged ≥65 years will to rise to 38.4% by 2050.[2] Surgical treatment outcomes for these elderly individuals vary considerably; therefore, we need to consider clinical indications and various factors such as anatomical factors, activity of daily living (ADL), and social background. Herein, we report a successful case of thoracic endovascular aneurysm repair (TEVAR) performed in a 106-year-old female. The patient and the family have provided permission for the publication of this case.
| Case Report | | |
A 106-year-old female patient was admitted with the diagnosis of aspiration pneumonia. Computed tomography (CT) scan revealed a 6-cm saccular aneurysm at the descending thoracic aorta [Figure 1], which was 5 cm a year ago. Since the patient had a back pain occasionally for a month, it was diagnosed with an impending rupture. | Figure 1: Computed tomography scan showed an aneurysm of 60 mm in the descending aorta. Bilateral external iliac artery were small in diameter (right: 5.9 mm and left: 5.8 mm), thus considered as a poor access case for thoracic endovascular aneurysm repair
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A multidisciplinary conference was convened to discuss her treatment option. She was super senile at 106 years, and her body size was extremely small (height: 136 cm, weight: 33 kg, and body mass index: 17.8). However, she was healthy, and her ADL was independent. No dementia or loss of hearing had been observed; she could walk using an aid cart and goes outside by herself. Since her anatomy was favorable and TEVAR seemed possible under local anesthesia, surgical intervention was decided.
The operation was performed under local anesthesia with intravenous sedation. The right common femoral artery was exposed through cut down. The bilateral external iliac artery had a diameter <6 mm; however, the Zenith Alpha Thoracic stent graft 30 mm × 155 mm (Cook Medical, Bloomington, IN, USA) was delivered smoothly and deployed. Final aortography showed no endoleak or retrograde dissection. Postoperative CT scan revealed no complications. She was discharged home on postoperative day 10 after rehabilitation. She maintained her ADL 1 year after the operation, and CT scan showed regression of the aneurysm to 50 mm [Figure 2]. She subsequently deceased 2 years after the operation due to decrepitude; however, maintained her ADL until 2 weeks before she passed away. | Figure 2: Three-dimensional-computed tomography scan 1 year after the operation showed regression of aneurysm to 50 mm in diameter
Click here to view |
| Discussion | | |
Herein, we reported a successful TEVAR for 106-year-old female with a poor access. The problem with the surgery for very senile patients is that the risk of surgery is unpredictable. This patient did not have dementia, could take care of most things herself, and had muscular strength allowing her to walk using a walker. Furthermore, the patient had suitable anatomy for TEVAR, enabling the procedure to be performed under local anesthesia. After multiple discussions with the family regarding the risks, a decision to perform TEVAR was made.
Even though there have been no reports on the results of TEVAR for nonagenarians and above, there have been reports of TEVAR for the elderly. Rango et al. reported that there is no difference in mortality between the >75 years old group and the younger group for elective TEVAR, and there were no mortalities in elective surgery cases for octogenarians and the ADL was maintained at the discharge.[3] Preventza et al. also reported that the 30-day mortality of 101 patients who underwent TEVAR at the age ≥80 years was 8.9%; 3.4% in the elective cases.[4] Thus, it is evident that elective surgery cases can be performed relatively safely even in the elderly, if the result of preoperative examination was acceptable.
In addition to surgical risks, medical costs are also the problems of surgery for the elderly. Yamauchi et al. reported the cost of cardiac surgery for those aged >80 years is about 20%–30% higher than for high-risk young cases.[5] To get an appropriate balance between life expectancy and cost, further studies will be needed in these super elderly population.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
NF receives consulting fee from Cook Medical, Endologix, Medtronic, and WL Gore.
| References | | |
| 1. | |
| 2. | Statistics Japan National Institute of Population and Social Security Research, 2019 revision. Available from: http://www.ipss.go.jp. [Last accessed on 2019 Nov 01].  |
| 3. | De Rango P, Isernia G, Simonte G, Cieri E, Marucchini A, Farchioni L, et al. Impact of age and urgency on survival after thoracic endovascular aortic repair. J Vasc Surg 2016;64:25-32. |
| 4. | Preventza O, Bavaria J, Ramaiah V, Moser GW, Szeto W, Wheatley G 3 rd, et al. Thoracic endografting is a viable option for the octogenarian. Ann Thorac Surg 2010;90:78-82. |
| 5. | Yamauchi T, Kubota S, Hasegawa K, Ueda H. Clinical results and medical costs of thoracic endovascular aortic repair in patients over 80 years of age. J Artif Organs 2019;22:61-7. |
[Figure 1], [Figure 2]
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