Abdominal Aortic Aneurysm Repair in Nonagenarians

Racial disparities in outcomes after intact abdominal aortic aneurysm repair

“…However, when the stakes are higher and these high-risk patients undergo open AAA repair, such as in the recent study from Hughes et al evaluating nonagenarians, the racial disparity broadens, with black patients over the age of 90 experiencing an 8-fold higher perioperative mortality compared to white patients. 19 However, in our current series, 83% of patients underwent EVAR, and, in contrast to prior studies, 10 black patients more often underwent EVAR than white patients (87% vs. 83%), which is likely reflective of changing practice patterns and increasing availability of EVAR. This increasing use of EVAR could explain the narrowing gap in outcomes across racial groups.…”

Is Conventional Open Repair for Abdominal Aortic Aneurysm Feasible in Nonagenarians?

“… 5 – 8 ) Although we agree with these previous authors who concluded that EVAR is feasible for nonagenarian patients with acceptable perioperative mortality, compared to octogenarians in our institution, there was no significant difference in mortality between nonagenarian and octogenarian patients after open repair and EVAR. The operative mortality in open repair patients was reported to be higher in other reports, at 18.3% and 25%, 5 , 6 ) but there were no deaths recorded in the present study over the first 30 days after surgery in the patients who had undergone open repair. ACS is widely known to be associated with high mortality rates 13 – 16 ) of 30%–70% following both open repair and EVAR.…”

“…As surgical risk assessments are heavily reliant on age, 6 , 11 , 12 ) they remain inadequate for the evaluation of surgical risk among nonagenarians. Goldstein et al reported that very elderly patients with more than five comorbidities showed significantly lower survival than those with five or less comorbidities.…”

Predicting failure to rescue after abdominal aortic aneurysm repair in elderly patients

“…6 Given these findings, it is imperative that surgeons weigh the risks of AAA repair compared to the risks of medical management in older patients with AAA. 2,[30][31][32] This is especially true given that the number of elderly patients is on the rise, which means that the number of elderly patients who meet the 5.5 cm criterion for AAA repair will be increasing as well. 5,15 Although our analysis is not designed to propose an age-specific diameter criteria for AAA repair, the increased risk of FTR that we observed among elderly patients suggests that the size threshold for repair should probably be adjusted in older patients.…”