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Background: Octogenarians are frequently denied open repair of complex abdominal aortic aneurysms (AAAs) and thoracoabdominal aortic aneurysms (TAAA) because of their increased surgical risk. Fenestrated endovascular aortic aneurysm repair (FEVAR) is an alternative to open repair of complex AAAs in high-risk patients. The purpose of this study was to assess perioperative outcomes of FEVAR among octogenarians.
Methods: Over a 24-month period, 84 high-risk patients (75 men and 8 women) underwent FEVAR using physician modified fenestrated Zenith endografts. 19 patients (23%)(15 men and 4 women) were octogenarians. Technical success was defined as complete exclusion of the aneurysm with successful catheterization and patent target arteries.
Results: Median age was 72 years (interquartile [IQR] range, 65-79) for the entire cohort and 83 yeas (IQR, 81-86) among octogenarians. All octogenarians were considered unfit for open repair and had a median SVS comorbidity score of 16 (IQR, 12-18). More octogenarians presented with symptomatic aneurysms (45% vs. 10%) and severe aortoiliac occlusive disease (40% vs. 25%). Their median aneurysm size was 6.2 cm (IQR, 5.4-6.8). Most aortic aneurysms in octogenarians were suprarenal (50%); 28% were thoracoabdominal and 32% juxtarenal. Endografts were customized to include 52 fenestrations/branches (33 renal, 12 superior mesenteric and 6 celiac arteries). Octogenarians were more likely to have unfavorable anatomy (42 % vs. 22%) because of severe suprarenal neck angulation (16%), reverse taper neck (16%) and circumferential thrombus at the renal arteries (11%). Severe preprocedural renal and visceral artery stenosis was present in 3 and 2 patients, respectively. Technical success for stenting of the fenestrated/branched arteries was 98% (51/52). One renal artery was lost in a patient with unfavorable anatomy. No mesenteric arteries were lost. Median procedure time was 267minutes (IQR, 158-339) and median fluoroscopy time 79 minutes (IQR, 66-91). No 30-day mortality occurred. Median hospital stay was 7 days (IQR, 6-9). Prolonged ileus (21%), blue toe syndrome (11%), access vessel injury (11%), worsening renal insufficiency (11%), pneumonia (5%) and renal artery dissection (5%) were the most frequent complications. No periprocedural paraplegia or strokes occurred.
Conclusions: FEVAR is safe and effective in the treatment of complex aortic aneurysms in octogenarians, even in those with unfavorable anatomy. Further evaluation of this technique in octogenarians is needed to define long-term outcomes, durability of the repair and effects on patient survival.