Evaluation of endovascular abdominal aortic aneurysm repair in nonagenarians

Abstract

ABSTRACT. The aim of this study was to investigate the safety and efficacy of endovascular abdominal aortic aneurysm repair (EVAR) in nonagenarians. From May 2003 to March 2011, 12 nonagenarian abdominal aortic aneurysm patients were treated with endovascular repair including two emergencies. The mean age of patients was 92.5 ± 1.6 years (range: 90-95 years), and 11 of the patients (91.7%) were men. Technical success, perioperative complications, and mortality were evaluated. The follow-up protocol consisted of computed tomography angiograms or ultrasounds performed at 3, 6, 9, and 12 months, and annually thereafter. Seven patients were operated under general anesthesia and five under local anesthesia. There was 100% technical success with no need for open conversion. The endografts used included two Endurant endografts, four Talent endografts, and six Zenith endografts. The mean operative time was 3.4 ± 1.3 h, mean procedural blood loss was 150.5 ± 60.5 mL, and mean postoperative length of stay was 8.4 ± 2.3 days. Mortality rates were 8.3% at 30 days, 16.7% at 1 year, 41.7% at 3 years, and 75% at 5 years. The mean survival of the 11 patients who expired beyond the first 30 days was 28.5 months (range: 9-73 months). Overall, EVAR in nonagenarians was associated with acceptable procedural success and perioperative morbidity and mortality. The medium and long-term results suggested that EVAR may be of limited benefit in some patients who are aged >90 years. Therefore, individual patient selection is very important.

Aortic aneurysm trials in octogenarians: Are we really measuring the outcomes that matter?

“…Of the 40 studies selected for further analysis 10,17–57 none were randomized controlled trials. There were 26 cohort studies, 4 case-control studies, and 10 case series.…”

“…The remaining reported on differences between general anesthesia and loco-regional anesthesia. 20,21,29,34…”

Type IA endoleak caused by interlocked suprarenal bare-metal stents after endovascular abdominal aortic aneurysm repair with successful endovascular rescue

“…Our usual practice is nonoperative management in this patient group. However, selective use of EVAR in octogenarians and nonagenarians has been shown to have acceptable success, [11][12][13] and given that our patient's AAA had expanded by >1 cm in <1 year to 6.8 cm, we offered EVAR.…”

A Late Post-EVAR Rupture in a 102-Year-Old Patient Related to a Type II Endoleak

“…Others nonagenarian's studies have reported similar results. 19,21,22 Shan et al 25 reported that Quality of Life on patients >80 years after EVAR, takes longer to recover compared with younger patients, and physical health domains recover more slowly than mental health domains. Pol et al 6 showed that recovery in QOL and the domains of mobility, self-care, and usual activities are delayed longer than expected on patients >80 years old.…”

“…Others nonagenarian’s studies have reported similar results. 19,21,22 Table 1 summarizes studies of nonagenarians undergoing EVAR.…”