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Endovascular Abdominal Aortic Aneurysm Repair Is Not Associated With Worse Outcomes In Octogenarians
Angelina Kim, Charles Zhang, Nakia Sarad, Rajeev Dayal, Andy Lee, Varuna Sundaram, Jing Li.
New York Presbyterian Queens, Flushing, NY, USA.
OBJECTIVES: Current literature shows worse outcomes in octogenarians undergoing endovascular abdominal aortic aneurysm repair (EVAR) including higher morbidity and mortality. We sought to compare the outcomes of octogenarians and non-octogenarians undergoing EVAR at our institution.
METHODS: Retrospective study of patients who underwent EVAR from January 1, 2016 to October 30, 2022 at a single institution. Patient demographics, aorta size, operative indication, postoperative outcomes, and re-intervention rates were collected and compared between cohorts using univariable analysis. Follow up data until September 1, 2023 was collected.
RESULTS: Seventy-five patients were included in the study with 18 in the octogenarian group and 57 in the non-octogenarian group. There were no significant differences in demographics or comorbidities except non-octogenarians were more likely to be active smokers (Table 1, p=0.02). Octogenarians were more likely to undergo non-elective repair (p=0.006). Non-elective indications included symptomatic AAA, rupture, and presence of an endoleak. Operative time was also longer in the octogenarian group (p=0.04). There was no difference in presence of type II endoleaks at the end of the case(p=0.48), and there were no differences in 30-day outcomes(Table 2). Long-term follow up data showed that 10 patients (18%) in the non-octogenarian group required re-intervention for type II endoleak while 2 (11%) in the octogenarian group required re-intervention (p=0.52). Mean time to re-intervention was 3.25 and 3.60 years for the non-octogenarian and octogenarian groups, respectively (p=0.31). There were 5 known deaths in the octogenarian group outside of the immediate 30-day window. Four out of 5 of these patients lived at least 2 years beyond their operation date, and one patient died 114 days later from unknown cause.
CONCLUSIONS: There were no significant differences in 30-day outcomes between the octogenarians and non-octogenarians. Though we recognize the inherent biases of the data, age alone does not appear to be a prognostic factor of outcomes in EVARs. Further studies should be done to determine what other factors should preclude physicians from offering repair in an older patient population.
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