Is age a determinant factor in EVAR as a predictor of outcomes or at procedure selection? Our experience

Abstract

IntroductionEndovascular aneurysm repair (EVAR) is the therapy of choice in high risk patients with abdominal aortic aneurysm. The good results described are leading to the broadening of clinical indications to younger patients. However, reintervention rates seem higher and even with successful treatment sometimes there is growth of the aneurysm sac and rupture, meaning a failure of the therapeutic goal. This study proposes to analyse the impact of age in patients' selection and post-EVAR results.MethodsThe clinical records of consecutive patients undergoing endovascular aneurysm repair, between 2001 and 2013, were retrospectively reviewed. Patients were divided according to age groups (<70, 70-80 and >80 years). Gender, body mass index, aneurysm anatomic features, neck characteristics, iliac morphology, surgical indication, endograft type, anesthesic risk classification, length of stay, reinterventions and mortality were analysed and compared.ResultsThe study included 171 patients, 161 (94.1%) men, and mean age 74.1±8.9 years. The age group under 70 had 32% of the patients. Only three characteristics were found different among age groups: 1) body mass index was higher in younger patients, with a considerable trend toward significance (P=0.06); 2) surgical indication, in the younger group, surgeon's and the patient's option were more proeminent (P<0.05); 3) erectile dysfunction was higher in elderly group (P<0.05). No other clinical and anatomical characteristics or final outcomes were found statisticaly different among age groups.ConclusionThe absence of statistically differences in mortality and reinterventions among age groups suggests that age by itself is not a relevant factor in endovascular aneurysm repair. Indeed, the three characteristics different in younger (obesity, sexual function and patient's choice) favor endovascular aneurysm repair.

Outcomes of Type II Endoleak Treatment Using Ethylene Vinyl Alcohol Copolymer (OnyxTM)

“…35 Abdominal aortic aneurysm is a disease of the elderly with median age at EVAR ranging from approximately 73-75 years. [36][37][38][39] The 5-year survival after EVAR ranges from 57%-75%. [40][41][42][43][44] Previous studies have shown that the majority of deaths after EVAR are due to non-surgical causes such as cardiovascular disease and cancer.…”

Management of abdominal aortic aneurysm in nonagenarians: A single-centre experience

“…18,19 In contrast, Machado et al. 20 reported no significant statistical differences in terms of mortality and re-interventions among different age group of patients who have undergone EVAR. 20…”

Evaluando la experiencia local: primeros 50 casos de reparo endovascular de aneurismas aórticos en Manizales, Colombia

“…Este estudio realizado corresponde a la primera investigación retrospectiva y analítica realizada en nuestra ciudad sobre EVAR, y muestra los primeros 50 casos intervenidos, pretendiendo esclarecer el comportamiento de una técnica innovadora en nuestra región. En esta evaluación, la edad de los pacientes fue similar a lo reportado por Machado et al en el 2016 4 , pero el diámetro promedio de los aneurismas intervenidos en nuestro centro fue mayor en tamaño, comparado con las publicaciones de Manning et al 5 y Vallejo et al en un estudio colombiano 6 . Huang et al encontró que los pacientes con diámetros del aneurisma superiores a 6 cm, como nuestros pacientes, tenían mayor mortalidad, complicaciones y reintervenciones 7 .…”