Can elderly diabetics survive aortic dissection surgery?
Patient's Query
Hi doctor,
The patient is an 89-year-old female. She is an insulin-dependent diabetic with a history of heart disease, found to have an aortic dissection. She became ill early in the morning and could not call for help. She was taken to the hospital eight hours after her first symptom.
She has been on Coumadin for several years. She also takes medicine for high blood pressure. Would she be a candidate for surgery? Do you believe the surgery would be survivable for her? Please help.
Thank you.
Hi,
Welcome to icliniq.com.
It is a complex situation, and more information would be required for further advice. Most importantly, how is the patient's condition now, and is there a comprehensive knowledge of her stress-bearing capacity and accurate imaging reports of the aortic dissection and other diseases?
The outcome of surgery would depend on some factors. I can give you some information that I think can help with your question, but it is not a replacement for an in-person evaluation. A diabetic patient of 90 years old is usually a terrible situation for most surgical operations under general anesthesia, but that is not always true. If the patient has no other problem, a very fit, active person with well-controlled diabetes, then non-emergency surgery is not always an out-of-the-scope thing.
This reluctance does not apply in emergencies where there is an imminent threat to life because of the problem. Age decreases our capacity to bear stress. And vascular surgery is a very high-stress event. And has a high risk of demise in patients who have heart disease and diabetes. In such patients, open surgery has up to 10 to 20 times the odds of death after surgery compared to those without any diseases for less than 60 years.
Another critical factor is the type of aortic dissection (your doctor would know) and whether it can be fixed with some non-surgical options like endovascular repair. It is an experimental trial and can be done only in selected cases. At this age, even if the person undergoing surgery survives the initial surgery, it might take a very long time to get back to a normal quality of life, sometimes even up to a year. At the same time, aortic dissection is a very high-priority emergency for the patient to survive. So, it is a highly complex situation.
Kindly discuss with your cardiothoracic and vascular surgeon the investigation reports of the patient.
I hope this helps.
Kindly revert in case of further queries.
Thank you.
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