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Single Center Experience with Abdominal Aortic Aneurysms in Octogenarians - The Endovascular Approach Is Not Better Than Open Repair.
Michael Gawenda, M.D., Professor, Payman Majd, MD, Thomas Luebke, MD, Jan Brunkwall, MD, Prof.
Department of Vascular Surgery, Universtiy of Cologne, Cologne, Germany.
Objectives: We studied the in-hospital mortality rate to access the value of conventional open repair (OR) versus endovascular aneurysm repair (EVAR) in an elderly population presenting with asymptomatic abdominal aortic aneurysm (AAA) undergoing elective repair.
Methods: During the period of January 1999 to December 2011, 781 (m:f=707:74, age in median 72 years; range 43-90) consecutive patients were treated electively for asymptomatic non-ruptured AAA in our department. Among these, 127 (m:f=110:17) were aged ≥80 years. The patients were divided into groups according to their age (<80 yrs. versus ≥80 yrs.) and therapy (OR versus EVAR). The main outcome measure was in-hospital mortality.
Additionally, a systematic review of the literature (PubMed, Web of Science ISI, Science Direct, Cochrane) and meta-analysis was performed. Considered for the analysis were studies published as full-length articles, reporting the outcome of patients aged ≥80 years comparing electively performed OR and EVAR for asymptomatic AAA. Studies including repair for symptomatic or ruptured AAA were excluded.
Results: The mortality rate following electively performed AAA repair was 1.4% (11/781). According to the therapeutic approach (OR versus EVAR) mortality rate was 1.4% (5/362) versus 1.4% (6/419).
When comparing mortality of the different therapeutic approach in the octogenarians (n=127), 2 of the patients that received OR (n=38) and 3 of the patients that received EVAR (n=89) died (5.3% versus 3.4%, P=NS). In younger patients (<80 years), hospital mortality was equal in OR and EVAR group (3/324; 0.9% versus 3/330, 0.9%).
Systematic review and meta-analysis revealed only three further single centre studies and three registers or multi-centre trials dealing with electively performed OR vs. EVAR for asymptomatic AAA in octogenarians.
Considering only the four single centre studies, the increase in operative mortality in AAA repair in octogenarians associated with OR was not statistically significant compared to EVAR (Peto OR, 0.499; 95% CI, 0.197 - 1.264; p = 0.143).
Conclusion: Our study confirms an acceptable mortality rate in electively performed therapy of AAA in octogenarians. In general, EVAR showed superiority to OR, but age-adjusted mortality rates were similar for OR and EVAR. Therefore, even octogenarians with an anatomy not suitable for an endovascular approach, should not be excluded from electively performed OR of their AAA.
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