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Acceptable risk but small benefit of endovascular aneurysm repair in nonagenarians.

Abstract：

BACKGROUND:We report the outcomes of a single-center experience with endovascular aneurysm repair (EVAR) in nonagenarians. METHODS:Via a retrospective medical records review, we identified all patients > or = 90 years old who underwent EVAR at a single university teaching hospital during a 5-year period (January 2004 to December 2008). Patients were evaluated for surgical risk factor profile, preoperative imaging, technical success, postoperative complications, length of hospital stay, and need for secondary intervention. In addition, mortality rates were evaluated at 30 days, 365 days, and 2 years. RESULTS:There were 18 nonagenarians (12 male, 67%) with a mean age of 91.2 years (range 90-95). Each patient averaged 3.5 risk factors, and the mean preoperative maximal aneurysm size was 68.3mm (range 50-105). Sixteen (89%) patients were treated on an elective basis, and two patients were emergently treated for aneurysm rupture, with one undergoing aortouni-iliac stenting with femoral-femoral bypass. All other patients in the study had bifurcated stent grafts. There was 100% technical success with no need for open conversion. The mean length of hospital stay was 4.3 days with a mean intensive care unit stay of 0.6 days. Systemic complications occurred in three patients (17%) including one death within 30 days. Secondary interventions were required in two patients (11%). One had endovascular treatment of a type I endoleak at 4 months, and a second patient underwent femoral-femoral bypass at 25 months for severe flow-limiting limb angulation. Mortality rates were 5.6% at 30 days, 41.2% at 365 days, and 58.3% at 2 years. Mean survival of the 11 patients who expired beyond the first 30 days was 17.5 months (range 4-50). Of these, mean survival of the nine patients treated electively was 20.2 months (range 7-50). Mean survival of the six patients still alive is 25.6 months (range 8-65). CONCLUSION:EVAR is safe in nonagenarians despite their advanced age and significant surgical risk factor profile. The procedure can be performed with excellent technical success and a low rate of perioperative complications. However, mortality rates after 30 days are significant. The substantial long-term mortality raises the question of possible treatment futility in this unique population. While age should not be a contraindication for EVAR, recommendations for the procedure should be based on individual patient selection.

journal_name

Ann Vasc Surg

journal_title

Annals of vascular surgery

authors

Jim J,Sanchez LA,Sicard GA,Curci JA,Choi ET,Geraghty PJ,Flye MW,Rubin BG

doi

10.1016/j.avsg.2009.10.009

subject

Has Abstract

pub_date

2010-05-01 00:00:00

pages

441-6

issue

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(09)00320-3

journal_volume

pub_type

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Acceptable risk but small benefit of endovascular aneurysm repair in nonagenarians.