Endovascular abdominal aortic aneurysm repair in the geriatric population

Abstract

Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date.

Elective Endovascular vs Open Repair for Elective Abdominal Aortic Aneurysm in Patients ≥80 years of Age: A Systematic Review and Meta-Analysis

“…The total blood loss, operative time, length of ICU stay, and overall hospital stay were significantly lower in patients undergoing endovascular repair. These updated findings are similar to previous reviews, 19,20 however, there are some important additional outcomes considered in the present review such as intra-operative outcomes, operative time and amount of blood loss, and length of ICU and hospital stay. An updated meta-analysis was required as the previous reviews on this subject were conducted nearly a decade ago.…”

“…The review by Saratzis et al noted that endovascular repair within an elderly population resulted in an excellent success rate (>90%) and a high level of safety. 19 The risk of early postoperative mortality and morbidity was significantly lower in patients receiving endovascular repair, compared to open repair. Further work by Biancari et al showed an increased risk of immediate postoperative mortality following open repair (RR 3.87, 95% CI: 3.19, 4.68) compared with endovascular repair.…”

“…The available evidence, in support of the findings of the present meta-analysis, indicates that endovascular repair may be a better surgical option compared to open repair in older patients, due to its faster operative time and improved recovery, lower blood loss, and reduced risk of mortality and complications. 19,20 But it should also be considered that these pooled results are generated from studies with a predominantly observational design which can be prone to biases.…”

“…There have been two systematic reviews that compared outcomes between the two management modalities in patients ≥80 years. 19,20 Both reviews found elective endovascular repair, compared to open repair, was associated with significantly lower mortality and morbidity in the early postoperative period. The findings suggested that in this elderly population, an endovascular repair can be offered with reasonable safety.…”