Key result
Age ≥85 years at the time of elective endovascular aneurysm repair was an independent adverse predictor of all-cause mortality compared to younger patients (HR 3.47).
Why the study?
There was concern regarding the risk of overtreating elderly patients with endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm.
Does age at the time of elective EVAR affect all-cause mortality in Japanese patients with abdominal aortic aneurysm?
Cohort (n=175)
No
Does age at the time of elective EVAR affect all-cause mortality in Japanese patients with abdominal aortic aneurysm?
Hazard Ratio: 3.47 (95% CI 1.92–6.28)
p-value: p=<0.001
In elderly Japanese patients undergoing elective EVAR for AAA, age ≥85 years is strongly associated with reduced long-term survival, highlighting the need to incorporate age and life expectancy into treatment guidelines.
May inform shared decision-making on elective EVAR in patients ≥85 years; leaves open whether age thresholds should guide selection in prospective trials.
PURPOSE: Our primary concern was the risk of overtreating elderly patients with endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm. We investigated the association between age at the time of EVAR and all-cause mortality in Japan's aging population by stratifying patients into age groups. METHODS: Data from 175 patients who underwent elective EVAR from 2012 to 2016 were analyzed. Patients were categorized into 3 age groups: <75 years, 75-84 years, and ≥85 years, based on Japan's healthy life expectancy and average life expectancy. Survival rates and risk factors for mortality were assessed across these patient groups. RESULTS: Among 175 patients, 3- and 5-year survival rates were significantly lower in elderly patients, with rates of 74.6% and 64.2% for those aged 75-84 years and 51.9% and 39.7% for those aged ≥85 years. Multivariate analysis identified age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and active cancer as independent adverse predictors of all-cause mortality, whereas obesity was identified as an independent protective predictor. CONCLUSIONS: Adjusting guidelines to incorporate not only comorbidities but also age could optimize outcomes and healthcare resource allocation by prioritizing EVAR for patients most likely to benefit in Japan's super-aging society.
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Nishibe et al. (2025) conducted a cohort in Abdominal aortic aneurysm (n=175). Age ≥85 years at the time of EVAR vs. Age <85 years (75-84 years and <75 years) was evaluated on All-cause mortality (HR 3.47, 95% CI 1.92-6.28, p=<0.001). Age ≥85 years at the time of elective endovascular aneurysm repair was an independent adverse predictor of all-cause mortality compared to younger patients (HR 3.47).
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