Cardiovascular Surgery, Vol. 11, No. 5, pp. 337–340, 2003  2003 The International Society for Cardiovascular Surgery Published by Elsevier Ltd. All rights reserved. 0967-2109/03 $30.00 www.elsevier.com/locate/cardiosur doi:10.1016/S0967-2109(03)00101-7 Should ruptured abdominal aortic aneurysms be repaired in the octogenarian?  Sean P. Roddy, R. Clement Darling III, Dale Maharaj, Kathleen J. Ozsvath, Manish Mehta, Philip S. K. Paty, Paul B. Kreienberg, Daniel Choi, Benjamin B. Chang and Dhiraj M. Shah Albany Medical College, Institute for Vascular Health and Disease MC157, 47 New Scotland Avenue, Albany, NY 12208, USA Purpose: Several investigators have suggested a dismal prognosis of ruptured abdominal aortic aneurysm (rAAA) repair in the elderly. The purpose of this study is to evaluate the morbidity and mortality of rAAA repair in octogenarians and compare it to that of a younger population. Methods: From 1980 to 2000, all patients undergoing emergent rAAA repair were divided into two groups based on their age; Group I: age 80, Group II: 80 years. Outcomes were evaluated based on a Chi-square test and a P-value 0.05 indicated statistical significance. Results: Over a 20-year period, 323 patients underwent rAAA repair through a left retroperi- toneal (74%) or standard transperitoneal (26%) approach. In Group I (age 80 years) and II (80 years), the overall 30-day mortality was 25 and 41% (P  0.05), respectively. Further- more, the elderly population had a higher incidence of death due to myocardial infarction (15 vs. 7%), as well as non-fatal cardiac and cerebrovascular events (17 vs. 4%) when compared to the younger patients. Conclusion: Although the elderly patients have an increased risk of having cardiac and cereb- rovascular events in the postoperative period, the treatment of rAAAs in these patients should not be any different than that of a younger population. The left retroperitoneal approach is feasible and beneficial for rAAA repair and is associated with a limited morbidity and mortality.  2003 The International Society for Cardiovascular Surgery. Published by Elsevier Ltd. All rights reserved. Keywords: abdominal, aneurysm, aortic, elderly, retroperitoneal, ruptured Introduction Of all the conditions treated by the vascular surgeon, none pose as formidable a task as ruptured abdomi- nal aortic aneurysms (rAAA). Advances in the man- agement of elective abdominal aortic aneurysm (AAA) have resulted in decreasing mortality. How- ever rAAA continues to have an alarming high mor- tality, ranging between 25 and 95% [1–5]. The Correspondence to: R. Clement Darling III. Tel.: +1-518-262-8720; fax: +1-518-262-6720; e-mail: darlinc@mail.amc.edu  Presented at the International Society for Cardiovascular Surgery 25th World Meeting, Cancun, Mexico, 9–13 September 2001. CARDIOVASCULAR SURGERY OCTOBER 2003 VOL 11 NO 5 337 approach to such patients can be theoretically non- selective (in which all patients are operated on) or selective (in which the patients’ surgical outcome is predicted based on certain risk factors and comorbid conditions). In the latter group, it is accepted that without surgical intervention the mortality rate is 100% [6]. While it may appear that the selective approach will pose a moral and ethical dilemma, clinicians may be forced to ration surgical resources for economic and budgetary reasons. As a result, several investi- gators have identified advanced age (80 years) as a risk factor that has a substantial negative impact on the mortality [7–9]. Over the past 20 years, we have not identified a significant difference between