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INTRODUCTION:
Thoracoabdominal aortic aneurysms present a specific and complex challenge for vascular surgeons. As patients are living longer and there is a decrease in operative morbidity and mortality associated with endovascular management of these aneurysms, the number of patients who have access to branched and fenestrated repair has expanded. We evaluated our experience in the endovascular treatment of thoracoabdominal aneurysms in octogenarians when compared to those patient less than 80 years old.
METHODS:
Prospectively collected data was analyzed in a retrospective manner. Inclusion criteria were any patient that underwent a fenestrated or branched endograft with either a commercially available device, or was enrolled in a corporate or physician-sponsored investigational device exemption trial. Data regarding patient’s age, preoperative comorbidities, complications including arrhythmia, endoleak, kidney injury, paraplegia, myocardial infarction (MI), stroke, respiratory failure, and mortality were collected and analyzed using the chi square test and the fisher exact test.
RESULTS:
Eighty-nine endovascular fenestrated/branched aortic aneurysm repairs were performed. Thirty-six patients had implantation of a sponsored investigational device. Mean follow-up was 7.8 months (Range: 2 days-3.2 years). Twenty-two (25%) of these patients were 80 years of age or older at the time of their repair with a mean age of 82.2 (Range: 80-87). Non-octogenarians had a mean age of 69.7 (Range: 55-79). Octogenarians were noted to have more pre-existing comorbidities including a higher rate of arrhythmia (p=0.02), hypertension (p=0.04), and prior stroke (p=0.02). Forty-one percent of octogenarians compared to 28% of non-octogenarians (p=0.25, NS) developed any complication after surgery as listed in the Table below. There were more frequent arrhythmias in the octogenarians but these did not lead to long-term morbidity in any cases. There were no other statistical differences in short-term and overall complication rate or hospital mortality between the two groups.
CONCLUSIONS:
FEVAR for thoracoabdominal aneurysms is safe in octogenarians based upon early follow-up. This cohort, although with significantly higher comorbidities, has a similar complication profile when compared to those patients less than 80 years of age. Studies looking at multi-institutional data and long-term outcomes are needed to further evaluate the effectiveness of FEVAR in this population.

Early Complications

	Age <80 (n=67)	Age > 80 (n=22)	p-value
Any complication, n, %	18 (28)	9 (41)	0.25
MI, n, %	0	0	1
Stroke/TIA	0	0	1
Paraplegia	0	0	1
Renal Failure	0	1 (5)	0.25
Arrhythmia	1 (2)	3 (14)	0.05
Bleeding	13 (20)	4 (18)	0.85
Vascular Complication	3 (5)	2 (9)	0.27
Hospital Mortality	1 (1)	1 (5)	0.38