Age is not a sole predictor of outcomes in octogenarians undergoing complex endovascular aortic repair

ObjectiveTo examine the perioperative, postoperative, and long-term outcomes of fenestrated/branched endovascular aneurysm repair (F/BEVAR) in octogenarians compared to nonoctogenarians.MethodsA multicenter, retrospective cohort study was conducted using the Vascular Quality Improvement database, which prospectively captures information on patients who undergo vascular surgery across 1021 academic and community hospitals in North America. All patients who underwent F/BEVAR endovascular aortic repair from 2012 to 2022, were included. Patients were stratified into two groups: those aged <80 years and those aged ≥80 years at the time of the procedure. The preoperative, intraoperative, and postoperative factors were compared between the two groups. Primary outcome was long-term all-cause mortality; secondary outcomes included aortic-specific mortality and aortic-specific reintervention.ResultsA total of 6007 patients (age <80 years, n = 4860; age ≥80 years, n = 1147) who had undergone F/BEVAR procedures were included. No significant difference was found in technical success, postoperative length of stay, length of intensive care unit stay, postoperative bowel ischemia, and spinal cord ischemia. After adjustment for baseline covariates, octogenarians were more likely to suffer from a postoperative complication (Odds Ratio (OR) 1.16; [95% CI 0.98 – 1.37], p < 0.001), be discharged to a rehabilitation center (OR 1.60; [95% CI 1.27 – 2.00], p < 0.001) or nursing home (OR 2.23; [95% CI 1.64 – 3.01], p < 0.001). Five-year survival was lower in octogenarians (83% vs. 71%, hazard ratio (HR) 1.70; [95% CI 1.46 – 2.0], p < 0.0001). Multivariate Cox proportional hazard analysis demonstrated that age was associated with increased all-cause mortality (HR 1.72, [95% CI 1.39 – 2.12], p < 0.001) and aortic-specific mortality (HR 1.92, [95% CI 1.04 – 3.68], p = 0.038). Crawford extent II aortic disease was associated with increase in all-cause mortality (HR 1.49; [95% CI 1.01 – 2.19], p < 0.001), aortic-specific mortality (HR 5.05; [95% CI 1.35 – 18.9], p =0.016) and aortic-specific reintervention (HR 1.91; [95% CI 1.24 – 2.93], p = 0.003). Functional dependence was associated with increased all-cause mortality (HR 2.90; [95% CI 1.87 – 4.51], p < 0.001), and aortic specific mortality (HR 4.93; [95% CI 1.69 – 14.4], p = 0.004).ConclusionsOur findings suggest that octogenarians do have a mildly increased mortality rate and rate of adverse events following F/BEVAR procedures. Despite this, when adjusted for other risk factors, on par with other medical comorbidities and therefore age should be strict exclusion criterion for F/BEVAR procedures, rather age should be considered in the global context of patient's aortic anatomy, health and functional status.