Stepwise Age-Related Outcomes of Elective Endovascular Abdominal Aortic Aneurysm Repair

Abstract

Objective. Endovascular repair of abdominal aortic aneurysms (EVAR) has largely supplanted open surgery over the past 2 decades. Faced with an aging population, the outcomes of EVAR among various age groups were examined. Method. Retrospective review of elective EVAR cases was performed at a single institution from 1998 to 2009. Patients were separated into 4 age groups for easy comparison. Perioperative data were analyzed using Fisher’s exact test. Results. Demographics were similar among the groups except for sex, BMI, and smoking status. The 30-day morbidity and mortality data were not statistically different among groups. From EVAR to end of the study, there was a 10.9% all-cause mortality rate (with no difference among groups) and an 8.0% reintervention rate (with the oldest age group having a lower reintervention rate; P < .03). Conclusions. EVAR remains a good treatment option for elective aneurysm repair despite advanced age, which alone does not appear to be an independent predictor of outcome.

Keywords

abdominal aortic aneurysm endovascular aneurysm repair elderly outcomes

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References

Pearce

. Abdominal aortic aneurysm. http://emedicine.medscape.com/article/463354-overview . Accessed December 21, 2009.

Parodi

Palmaz

Barone

. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491-499.

Norwood

Lloyd

Bown

. Endovascular abdominal aortic aneurysm repair. Postgrad Med J. 2007;83:21-27.

Schermerhorn

O’Malley

Jhaveri

. Endovascular vs open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med. 2008;358:464-474.

The United Kingdom EVAR Trial Investigators, Greenhalgh

Brown

. Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med. 2010; 362:1863-1871.

De Bruin

Baas

Buth

. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med. 2010;362:1881-1889.

Prenner

Turnbull

Malik

. Outcome of elective endovascular abdominal aortic aneurysm repair in octogenarians and nonagenarians. J Vasc Surg. 2010;51:1354-1359.

Schwarze

Shen

Hemmerich

. Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001-2006. J Vasc Surg. 2009;50:722-729.

Raval

Eskandari

. Outcomes of elective abdominal aortic aneurysm repair among the elderly: endovascular versus open repair [published online ahead of print January 17, 2011]. Surgery. http://www.sciencedirect.com/science/article/pii/S0039606010005866 . Accessed December 6, 2011.

10.

Ballotta

Da Giau

Gruppo

. Elective abdominal aortic aneurysm repair in the very elderly: a systematic review. Minerva Medica. 2009;100:95-103.

11.

Henebiens

Vahl

Koelemay

. Elective surgery of abdominal aortic aneurysms in octogenarians: a systemic review. J Vasc Surg. 2008;47:676-681.

12.

H.R.1213—Screening Abdominal Aortic Aneurysms Very Efficiently Act of

2009. http://www.opencongress.org/bill/111-h1213/show . Accessed October 31, 2010.

13.

Lindsay

. Abdominal aortic aneurysms: ruptured. In: Cronenwett

Johnston

, eds. Rutherford’s Vascular Surgery. 7th ed. Philadelphia, PA: Saunders Elsevier; 2010:1994-2013.

14.

Lederle

Wilson

Johnson

. Immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346:1437-1444.

15.

The United Kingdom Small Aneurysm Trial Participants. Long-term outcomes of immediate repair compared with surveillance of small abdominal aortic aneurysms. N Engl J Med. 2002;346:1445-1452.

16.

EVAR trial participants. Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet. 2005;365:2179-2186.

17.

EVAR trial participants. Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet. 2005;365:2187-2192.

18.

Vogel

Dombrovskiy

Graham

. Elective abdominal aortic aneurysm repair: relationship of hospital teaching status to repair type, resource use, and outcomes. J Am Coll Surg. 2009;209:356-363.

19.

Hill

McPhee

Messina

. Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era. J Vasc Surg. 2008;48:29-36.

20.

Carpenter

Baum

Barker

. Impact of exclusion criteria on patient selection for endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2001; 34: 1050-1054.

21.

Wolf

Fogarty

Olcott

IV . Endovascular repair of abdominal aortic aneurysms: eligibility rate and impact on the rate of open repair. J Vasc Surg. 2000; 32: 519-523.