Key result
Although octogenarians undergoing elective EVAR had lower 5-year survival than younger patients (39.3% vs 60.6%, P=0.039), age ≥80 years was not an independent predictor of long-term mortality.
Why the study?
The need to adjust indications for elective AAA repair in patients with a limited life-span warranted a specific evaluation of postoperative results and long-term survival in octogenarians.
Does elective EVAR in octogenarians result in similar postoperative complications and long-term mortality compared to patients under 80 years of age?
Cohort (n=241)
Does elective EVAR in octogenarians result in similar postoperative complications and long-term mortality compared to patients under 80 years of age?
Absolute Event Rate: 39.3% vs 60.6%
p-value: p=0.039
Elective EVAR can be safely considered in octogenarians without clear life-limiting conditions, as age ≥ 80 years is not an independent predictor of long-term mortality or increased postoperative complications.
May support selective EVAR in octogenarians; leaves open need for randomized confirmation of outcomes.
AIM: The need to adjust the indications of elective abdominal aortic aneurysm (AAA) repair among patients with a limited life-span deserves a specific evaluation for octogenarians. The aim of this study was to compare the postoperative results and the long-term survival after endovascular repair of abdominal aortic and/or iliac aneurysms (EVAR) in octogenarians compared with patients under 80 years of age. METHODS: Retrospective analysis of 241 consecutive patients who underwent an elective EVAR between 2000 and 2017. EVAR was not considered among patients with clear life-limiting conditions. Patients receiving other than commercially standard infra-renal endoprostheses were excluded. RESULTS: Seventy patients (29.0%) were octogenarians. They had a lower rate of active smoking (10.0% vs. 30.4%, P < 0.001) and a higher prevalence of previous cerebrovascular disease (21.4% vs. 11.7%, P = 0.055) than younger patients. Thirty-day/in-hospital complication and mortality rates were not significantly higher among octogenarians when compared with younger patients (24.3% vs. 16.9% and 2.9% vs. 2.4%, respectively). Octogenarians had a lower long-term survival at 1, 3 and 5 years (92.6% vs. 93.3%, 67.7% vs. 78.0% and 39.3% vs. 60.6%, P = 0.039) in the bivariate analysis. However, an age ≥ 80 years per se was not an independent predictor of survival after adjustment for confounding factors. CONCLUSION: An age above 80 years was not associated with an increased risk of postoperative complications or long-term mortality. Our results suggest that EVAR can be considered in elderly patients without a clear life-limiting condition and with a suitable aneurysm anatomy. Geriatr Gerontol Int 2021; 21: 392-397.
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García et al. (2021) conducted a cohort in abdominal aortic and/or iliac aneurysms (n=241). Age ≥ 80 years (octogenarians) vs. Age < 80 years was evaluated on Long-term survival at 5 years (p=0.039). Although octogenarians undergoing elective EVAR had lower 5-year survival than younger patients (39.3% vs 60.6%, P=0.039), age ≥80 years was not an independent predictor of long-term mortality.
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