Surgical treatment of elderly patients with infrarenal abdominal aortic aneurysm

Cappello, Enrico; Spinetti, Fabio; Lorenzo, M Di; Franco, Elio

doi:10.1186/1471-2318-11-s1-a6

Cited by 1 publication

(1 citation statement)

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“…The pooled mortality rates from our included studies (5.9% in octogenarians and 4.2% in non-octogenarians) remain in line with the previously reported mortality rates in the literature for elective FEVAR, ranging between 2% and 5%. 22 , 23 Furthermore, when compared with mortality results for open surgical repair of short neck infrarenal and juxtarenal AAA in octogenarians, which range from 4% 24 to 8.5% 15 and even up to 20%, 8 the mortality rates following FEVAR in our review seem to confirm the viability of this treatment option in octogenarians.…”

Section: Discussionsupporting

confidence: 63%

Systematic review of the results of fenestrated endovascular aortic repair in octogenarians

Elahwal,

Richards,

Imsirovic

et al. 2024

annals

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Introduction With the increasing life expectancy of Western populations, more octogenarians are presenting with large abdominal aortic aneurysm (AAA). Endovascular repair offers a less invasive alternative and older patients who may not have been offered open repair in the past are now being considered for elective repair with this approach. Age in isolation may not be the only consideration in recommending elective aneurysm repair. We aimed to review the literature on complex endovascular AAA repairs (mainly fenestrated endovascular aortic repair [FEVAR]) in octogenarians. Methods A literature search was conducted using the Ovid Medline®, Embase® and Cochrane Library databases for articles published up to January 2022. All English language publications from 1995 onwards were eligible for inclusion. Search terms included: “FEVAR”, “F-EVAR”, “fenestrated EVAR”, “fenestrated endovascular aortic repair”, “fenestrated endovascular aneurysm repair”, “fenestrated AAA repair”, “fenestrated endograft”, “fenestrated stent graft”, “fenestrated”, “endograft”, “EVAR”, “octogenarian”, “elderly”, “above 80” and “over 80”. Methods The literature search identified 134 potential articles. Following qualitative assessment by two independent appraisers, this was refined to 11 studies, in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) statement. Results The primary outcome measure was 30-day mortality, which was highly variable, ranging from 0% to 9% in octogenarians and from 0% to 5% in non-octogenarians. However, these differences were only found to be statistically significant in two studies. The secondary outcome measures included technical success rates, major adverse events, reintervention rates, freedom from reintervention, target vessel patency, freedom from target branch instability, and length of hospital and intensive care unit stay. No statistically significant differences were found between octogenarians and non-octogenarians. Long-term survival was significantly lower for octogenarians in two studies. Conclusions The perioperative outcomes of FEVAR in octogenarians are comparable with those of younger patients. FEVAR therefore appears to be an acceptable option for complex endovascular aneurysm repairs in carefully selected octogenarians. Nevertheless, this review highlights the paucity of published data on the outcomes of endovascular repair of complex aneurysms in octogenarians.

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