Early Outcomes After Branched and Fenestrated Endovascular Aortic Repair in Octogenarians

Makaloski, Vladimir; Kölbel, Tilo; Rohlffs, Fiona; Behrendt, Christian‐Alexander; Law, Yuk; Debus, Eike Sebastian; Tsilimparis, Nikolaos

doi:10.1016/j.ejvs.2018.08.009

Cited by 15 publications

(16 citation statements)

References 21 publications

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“…Fenestrated-branched endovascular aortic repair (F-BEVAR) has allowed treatment of pararenal and thoraco-abdominal aortic aneurysms (TAAAs) in elderly and fragile patients who would otherwise be unfit for open surgical repair. 1 However, post-operative complications, re-interventions, and the requirement for lifelong surveillance may compromise the patient's quality of life (QoL). 2 The European Society for Vascular Surgery guidelines recommend against elective abdominal aortic aneurysm (AAA) repair in patients with a life expectancy of less than two to three years.…”

Section: Introductionmentioning

confidence: 99%

Pre-operative Psoas Muscle Size Combined With Radiodensity Predicts Mid-Term Survival and Quality of Life After Fenestrated-Branched Endovascular Aortic Repair

Kärkkäinen

Tenorio

Oksala

et al. 2020

European Journal of Vascular and Endovascular Surgery

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This study investigated a novel surrogate measure of sarcopenia called lean psoas muscle area (LPMA) and its feasibility as a predictor of survival, outcomes, and quality of life after fenestrated-branched endovascular aortic repair (F-BEVAR). LPMA was calculated by multiplying psoas muscle area by radiodensity measured from a single axial pre-operative computed tomography angiography slice at the L3 level. LPMA proved to be the strongest independent pre-operative predictor of mid term survival after F-BEVAR, especially in the elderly. In addition, high LPMA was associated with better quality of life after repair. Thus, LPMA can be used to identify suitable candidates for F-BEVAR. Objective: To investigate the association between psoas muscle area (PMA) and density (PMD) with survival and quality of life (QoL) after fenestrated-branched endovascular aortic repair (F-BEVAR). Methods: The study included 244 consecutive patients enrolled in a prospective study to investigate outcomes of F-BEVAR. Pre-operative computed tomography angiography was used to measure PMA (cm 2) and PMD (Hounsfield unit [HU]) at the L3 level. Lean PMA (LPMA) was calculated (PMA Â PMD). Patients were divided into two groups using the LPMA cut off point based on a Cox hazard model. Group A was defined as LPMA !350 (n ¼ 79) and group B as LPMA < 350 cm 2 Â HU (n ¼ 165). QoL was assessed at baseline and at 12 months using the Short Form-36. Results: Patients in group A were younger (mean age 72 AE 8 vs. 76 AE 7 years; p < .001), more often male (95% vs. 59%; p < .001), and had higher body mass index (30 AE 6 vs. 27 AE 5 kg/m 2 ; p ¼ .001). There were no major differences in comorbidities, aneurysm extent, or procedural measures between the groups. Thirty day mortality (0% vs. 0.6%; p ¼ 1.0) and major adverse event rates (15% vs. 24%; p ¼ .18) were similar in groups A and B. At three years, patient survival was 94% AE 3% in group A and 75% AE 4% in group B (hazard ratio [HR] 0.20, 95% confidence interval [CI] 0.07e0.56; p ¼ .002). The three-year survival difference was even more prominent in patients aged !75 years: 100% for group A and 72% AE 5% for group B (HR 0.12, 95% CI 0.02e0.86; p ¼ .035). Patients in group A had significantly higher QoL scores at baseline and at 12 months. LPMA was the strongest independent predictor of survival during follow up in multivariable analysis (adjusted HR 0.59 per 1 standard deviation, 95% CI 0.40e0.87; p ¼ .008). Conclusion: A high LPMA was independently and strongly associated with better mid term survival and QoL after F-BEVAR. LPMA may help to identify the best candidates for F-BEVAR among elderly patients.

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Section: Introductionmentioning

confidence: 99%

Pre-operative Psoas Muscle Size Combined With Radiodensity Predicts Mid-Term Survival and Quality of Life After Fenestrated-Branched Endovascular Aortic Repair

Kärkkäinen

Tenorio

Oksala

et al. 2020

European Journal of Vascular and Endovascular Surgery

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“…The characteristics of the 11 included studies are summarised in Table 2 . Six papers described single centre cohorts, 14 , 16 – 20 two studies included data from two centres 1 , 13 and three studies involved national level cohorts. 2 , 15 , 21 Data in most of the studies were collected prospectively in databases for complex AAA repairs and were studied retrospectively.…”

Section: Resultsmentioning

confidence: 99%

“… 1 , 2 , 13 , 17 – 19 , 21 The risk of selection bias in all studies is recognised and has been addressed in multiple studies. 1 , 2 , 13 , 16 …”

Section: Resultsmentioning

confidence: 99%

Systematic review of the results of fenestrated endovascular aortic repair in octogenarians

Elahwal,

Richards,

Imsirovic

et al. 2024

annals

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Introduction With the increasing life expectancy of Western populations, more octogenarians are presenting with large abdominal aortic aneurysm (AAA). Endovascular repair offers a less invasive alternative and older patients who may not have been offered open repair in the past are now being considered for elective repair with this approach. Age in isolation may not be the only consideration in recommending elective aneurysm repair. We aimed to review the literature on complex endovascular AAA repairs (mainly fenestrated endovascular aortic repair [FEVAR]) in octogenarians. Methods A literature search was conducted using the Ovid Medline®, Embase® and Cochrane Library databases for articles published up to January 2022. All English language publications from 1995 onwards were eligible for inclusion. Search terms included: “FEVAR”, “F-EVAR”, “fenestrated EVAR”, “fenestrated endovascular aortic repair”, “fenestrated endovascular aneurysm repair”, “fenestrated AAA repair”, “fenestrated endograft”, “fenestrated stent graft”, “fenestrated”, “endograft”, “EVAR”, “octogenarian”, “elderly”, “above 80” and “over 80”. Methods The literature search identified 134 potential articles. Following qualitative assessment by two independent appraisers, this was refined to 11 studies, in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. Results The primary outcome measure was 30-day mortality, which was highly variable, ranging from 0% to 9% in octogenarians and from 0% to 5% in non-octogenarians. However, these differences were only found to be statistically significant in two studies. The secondary outcome measures included technical success rates, major adverse events, reintervention rates, freedom from reintervention, target vessel patency, freedom from target branch instability, and length of hospital and intensive care unit stay. No statistically significant differences were found between octogenarians and non-octogenarians. Long-term survival was significantly lower for octogenarians in two studies. Conclusions The perioperative outcomes of FEVAR in octogenarians are comparable with those of younger patients. FEVAR therefore appears to be an acceptable option for complex endovascular aneurysm repairs in carefully selected octogenarians. Nevertheless, this review highlights the paucity of published data on the outcomes of endovascular repair of complex aneurysms in octogenarians.

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“…However, contrary reports that could not show a relationship between age and peri-operative adverse outcomes exist [30], and it is not conclusively understood whether the often-proclaimed association of age and adverse events is routinely affected by confounding co-morbidities and selection bias. In the case of FEVAR, a growing body of literature investigates the feasibility and safety of the procedure in octogenarians with varying results [19][20][21][31][32][33][34]. Studies largely agree that it remains a valuable option to consider in patients fit for the procedure [19,31,32], even though selected studies report an increased mortality or risk of non-home discharge in octogenarians [19,21].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Age on Peri-Operative Outcomes after FEVAR

Hofmann¹,

Leinweber²,

Assadian³

et al. 2023

JCM

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Introduction: Fenestrated endovascular aortic repair (FEVAR) has become a popular custom-made treatment option for juxtarenal and pararenal aneurysms. It has been previously investigated whether octogenarians as a distinct subgroup are at increased risk for adverse outcomes after FEVAR. With diverging results and an inconclusive understanding of age as a risk factor in general, an analysis of the historical data of a single center was conducted to add to the available body of evidence and further investigate the effect of age as a continuous risk factor. Methods: A retrospective data analysis of a prospectively maintained single-center database of all patients who underwent FEVAR at a single department of vascular surgery was performed. The main endpoint was post-operative survival. In addition to association analyses, potential confounders such as co-morbidities, complication rates, or aneurysm diameter were examined. In terms of sensitivity analyses, logistic regression models were created for the dependent variables of interest. Results: During the observation period from April 2013 to November 2020, 40 patients over the age of 80 and 191 patients under the age of 80 were treated by FEVAR. The 30-day survival showed no significant difference between the groups (95.1% in octogenarians and 94.3% in patients under 80 years of age). The sensitivity analyses conducted also showed no difference between the two groups, and complication and technical success rates were comparable. The aneurysm diameter was 67 ± 13 mm in the study group and 61 ± 15 mm in those under 80 years of age. Additionally, the sensitivity analyses showed that age as a continuous variable exhibits no effect on the outcomes of interest. Discussion: In the present study, age was not associated with adverse peri-operative outcomes after FEVAR, including mortality, lower technical success rates, complications, or length of hospital stay. Essentially, the most highly associated factor with hospital and ICU length of stay was time spent in surgery. However, octogenarians had a significantly larger aortic diameter at the time of treatment, which might indicate the potential introduction of bias by pre-interventional patient selection. Nevertheless, the usefulness of research on octogenarians as a distinct subgroup might be questionable regarding the scalability of results, and future studies might focus on age as a continuous risk factor instead.

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Early Outcomes After Branched and Fenestrated Endovascular Aortic Repair in Octogenarians

Cited by 15 publications

References 21 publications

Pre-operative Psoas Muscle Size Combined With Radiodensity Predicts Mid-Term Survival and Quality of Life After Fenestrated-Branched Endovascular Aortic Repair

Pre-operative Psoas Muscle Size Combined With Radiodensity Predicts Mid-Term Survival and Quality of Life After Fenestrated-Branched Endovascular Aortic Repair

Systematic review of the results of fenestrated endovascular aortic repair in octogenarians

The Effect of Age on Peri-Operative Outcomes after FEVAR

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