Endovascular Treatment of Asymptomatic Abdominal Aortic Aneurysms in Octogenarians: Factors Influencing Long-term Survival

Abstract

Beyond the age of 80years, the preventive treatment of an asymptomatic abdominal aortic aneurysm (AAA) has to be decided in light of the life expectancy which it is difficult to evaluate, but it is important to determine who in this population will benefit from it. The objective of our study was to determine the factors influencing short-term mortality and long-term survival in patients aged 80 years and older after the endovascular treatment of AAAs (EVAR). We present a retrospective analysis of the prospective databases of 4 French academic departments of vascular surgery, bringing together the data of all the patients presenting an AAA who were treated by EVAR between 1998 and 2011. Logistic regression and multivariate analysis with a Cox survival model were used to determine the factors influencing perioperative and long-term mortality. The cumulative rate of events for the measurement of survival was calculated with the technique of Kaplan-Meier. We treated 345 octogenarians and 339 younger patients. The average follow-up was 40months. Average survival was 75% at 36months and 49% at 60months. There was no evidence of any risk factor influencing mortality at 30days in the octogenarians. However, chronic kidney disease (odds ratio [OR]=3.95, P<0.001) and chronic respiratory failure (OR=2.62, P<0.001) proved to be independent factors of a poor long-term prognosis. The treatment by stent graft in octogenarians is effective in the long term. The presence of an impaired renal function or respiratory failure in this population could put into question the operative indication.