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Fenestrated Endovascular Aneurysm Repair (FEVAR) Among Octogenarians with Complex AAAs at High and Standard Risk for Open Repair.
David E. Timaran, M.D.1, Martyn Knowles, MD2, Marilisa Soto-Gonzalez, MD1, Tarik Ali, MD1, Melissa Kirkwood, MD1, Shirling Tsai, MD1, John Modrall, MD1, Mujtaba Ali, MD1, John Rectenwald, MD1, Carlos Timaran, MD1.
1University of Texas Southwestern Medical Center, Dallas, TX, USA, 2University of North Carolina health care, chapel hill, NC, USA.
OBJECTIVE
Octogenarians with complex abdominal aortic aneurysms (AAAs) are at higher risk of death and morbidity after open repair. FEVAR is an alternative to open repair for high-risk patients, such as octogenarians. The aim of this study is to evaluate peri-operative and mid-term outcomes of FEVAR among octogenarians at high and standard risk for open repair.
METHODS
During a 2-year period, 85 patients (68 men [78%], and 17 women [22%]) underwent FEVAR using Zenith Fenestrated AAA Endovascular Grafts (70%), Zenith p-Branch (7%) and fenestrated Custom Made Devices (22%). Demographics, perioperative and follow-up outcomes of patients aged > 80 years (n=18 [21%]) and patients aged < 80 years (n=67 [79%]) were compared. Chi-square or Fisher test were used for categorical variables and non-parametric tests for continuous variables. Kaplan-Meir curve was used for survival analysis.
RESULTS
Median age was 73 years (interquartile [IQR] 68-79 years) for the entire cohort and 84 years (IQR, 81-86 years) among octogenarians. Median aneurysm size was 56 mm (IQR: 53-62 mm). The median number of fenestrations was 3. Pre-operatively, octogenarians had higher SVS score (5.5 [IQR, 5-7] vs 5 [IQR, 3-6] p=0.01) and lower BMI (26 [IQR, 21-27] vs 28 [24-32] p=0.04). Intra-operatively, technical success was 100% for both groups. The median operative time for octogenarians was 224 minutes (IQR, 160-272) vs. 212 minutes (IQR, 177-281) in in patients <80 years (p=0.59). The median hospital length of stay was 3.5 days (IQR,2-5) for octogenarians vs. 4 (IQR, 2-5) in younger patients (p=0.87). ICU length of stay was 2 days for patients from both groups (IQR, 1-3). The rate of postoperative complications was 28% for octogenarians and 36% for patients aged < 80 years (p=0.5). None of the patients in this series required dialysis. No 30-day deaths occurred.
The 20-month estimated survival rate was 75% in octogenarians and 91% in patients <80 years (p=0.1). The rate of re-interventions at 20 months was 10% for octogenarians and 57% for younger patients (p=0.09).
CONCLUSIONS
FEVAR is safe and effective procedure for octogenarians at high and standard risk for open repair that are not eligible for standard EVAR. In fact, octogenarians had similar midterm outcomes compared to younger patients with superiority lower the rate of re-interventions at 20 months.
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