WTP4.06 Endovascular aneurysm repair in older patients

With increasing life expectancy, older people with abdominal aortic aneurysms (AAA) are referred to vascular surgery. Endovascular aneurysm repair (EVAR) is performed percutaneously under local anaesthetic and has lowered intervention thresholds, but it is not clear if this is justified. We aimed to define whether it is appropriate to treat older people with threshold AAAs. A retrospective review of a prospectively maintained EVAR database was performed (April 2013 to April 2024). Patients aged 80-years or more at time of intervention were identified. Outcomes analysed included peri-operative mortality, length of stay (LoS), discharge destination, re-admissions, re-intervention rates, and survival. 131 patients were identified (14 fenestrated EVARs were excluded from analysis); 107 (91.5%) were male and median age was 82-years. Median AAA size diameter was 6cm. 116 (99.1%) were elective procedures and 1 (0.9%) intervention for rupture. There were 3 (2.5%) in-hospital deaths. Median LoS was 3 days (range 1-59), and 113 (96.6%) patients were discharged home. There were 315 re-admissions (under any specialty) in 95 (81.2%) patients. Median LoS per admission was 4 days, and 48 (15.2%) were elective. Re-intervention was performed in 13 (11.1%) patients. Survival at 1-year and 5-years was 85.1% and 36.9% respectively. EVAR can be performed safely in older patients; importantly functional capacity appears to be preserved with most patients discharged home. However, as this patient group are at increased risk of death, AAA intervention will change mode of death without necessarily extending life. From a population perspective it seems unlikely that this is a cost-effective intervention.