Considerations with Respect to Elective Abdominal Aortic Aneurysm Repair in Older People

BACKGROUND: The epidemiology of abdominal aortic aneurysm (AAA) is changing, with progressively more older patients receiving repair. Advancing age associates with an increased procedural risk but also with a decreasing lifetime rupture risk. This national study aims to provide background information for decision-making in older people. METHODS: National administrative data (Statistics Netherlands) were used to estimate time-varying trends in the age and sex distribution of patients who underwent AAA repair, the age-procedural-risk relationships, and survival-time following successful AAA repair. RESULTS: Between 1995 and 2023, 48,557 patients underwent elective AAA repair. The mean age at repair increased from 69.9 to 73.9 years (P < 0.001). The proportion octogenarians almost tripled from 7.3% to 21.4%, and the proportion of women increased from 11.1% to 15.3% (both P < 0.001). Age-at-repair strongly influenced median survival following elective repair; mean survival following repair for 70-year-old patients equaled 10.1 years for men and 8.7 years for women but decreased to 6.2 and 6.1 years for men and women at 80 years. A progressive age-at-repair- 90-day mortality risk relationship was observed for open repair, with the risk exceeding 5% in patients over 75 years. Risk was more pronounced in women. Procedural risk for endovascular repair (90-day mortality) was less than 2% and 3%, respectively, for men and women under 80 years, but risk increased for those over 80 years. CONCLUSION: Implementation of age-specific intervention thresholds appears justified. Considering their high procedural risk for open repair, conservative or deferred management should be considered in women over 77 years who are not eligible for endovascular repair.