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OBJECTIVES:
Due to increasing life expectancy, the number of nonagenarians meeting size criteria for elective repair of infrarenal abdominal aortic aneurysm (AAA) continues to increase. This study reports the outcomes of endovascular aortic aneurysm repair (EVAR) in nonagenarians.
METHODS:
A retrospective review was undertaken of all nonagenarians who underwent EVAR from January 2001 to June 2012. Patient demographics, hospital course and follow up visits were analyzed. This group was compared with nonagenarians with > 5 cm AAA who did not undergo EVAR (control group). Survival rates and outcomes were determined using the Kaplan-Meier method with Logrank test.
RESULTS:
Of 1085 consecutive patients who underwent EVAR during this period, 23 were nonagenarians. Seventy-four percent were male. Mean age of individuals undergoing EVAR was 91.95 ± 2.4 years. The control group consisted of 20 nonagenarians managed using non-surgical means. Median follow-up was 31 months (range, 1- 87). The 30- day mortality rate was 9% after EVAR. Median hospital length of stay after EVAR was 3 days (range, 1-14 days). Median survival in the EVAR group was 44 months (interquartile range [IQR], 15-64 months) versus 9 months in the control group (IQR range, 1-24 months) (p <0.001) (Figure 1). Multivariate analysis found EVAR to be the only independent variable associated with increase in survival (hazard ratio: 0.2, confidence interval 0.1 - 0.7; p=0.003). In subgroup analysis, male patients who did not have chronic renal failure had the longest overall survival following EVAR.
CONCLUSIONS:
EVAR in nonagenarians has acceptable perioperative mortality and improves overall survival compared with non-surgical therapy.