Aortic Aneurysm in Elderly Patients
The appropriateness of endovascular abdominal aortic repair (EVAR) of uncomplicated abdominal aortic aneurysm (AAA) is dependent on the risk/benefit ratio, particularly in patients >80 years old with possible short life expectancy. The aim was to evaluate the survival of patients >80 years old after EVAR and analyse predictors of late mortality, in order to analyse the efficacy of the EVAR treatment in these patients.
A prospective evaluation of patients >80 years old treated by nonurgent EVAR, from 2006 to 2015, was performed; 30-day mortality and long-term survival were evaluated, and independent risk factors for mortality were investigated by multivariate logistic and Cox analysis.
In an 8-year period, over a total of 1135 EVAR, 201 (16%) were performed in patients >80 years old. The mean age was 84 ± 2 years (min, 81; max, 100) and 84% were male, and the mean AAA diameter was 61 ± 8 mm. Thirty-four patients (16%) had a score of 4 as per American Society of Anesthesiologist (ASA). Overall 30-day mortality was 2% and was significantly greater in ASA 4 compared with ASA <4 (9.4% vs 0.6% P = 0.04) as confirmed also by multivariate analysis (OR: 12.7, 95% CI 1.1–141.8). The mean follow-up was 36 ± 18 months, and the overall survival at 1, 2, 3 and 5 years was 88 ± 2%, 84 ± 3%, 79 ± 3% and 56 ± 5%, respectively. At the multivariate, Cox regression ASA 4 and peripheral artery obstructive disease (PAOD) were the only independent predictors for midterm mortality (HR: 2.0, 95% CI 1.01–3.90, P = 0.04 and HR: 2.3, 95% CI 1.02–5.3, P = 0.04, respectively). The 2-year survival was significantly influenced by the presence of both ASA 4 and PAOD, one ASA 4 or PAOD or any of the two risk factors: 33 ± 27%, 68 ± 8% and 93 ± 3%, respectively, and P = 0.02. Only patients with one or no risk factors reached the 5-year follow-up.
EVAR in >80-year-old patients is associated with an overall low early mortality rate of 2% especially in ASA < 4, 0.6%. The survival of patients with none or only one risk factor justify the treatment for AAA; however, patients with ASA 4 and PAOD had a significantly higher mortality and reduction of life expectancy; therefore, the EVAR treatment could be justified only in particular cases of AAA with impending rupture.
KeywordsAbdominal aortic aneurysm Endovascular repair Octuagenarian
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