Endovaskuläre Aneurysmachirurgie beim alten Menschen - Methode der ersten Wahl?

Abstract

During the past decade, endovascular aneurysm stent graft repair (EVAR) of abdominal aortic aneurysms has emerged as a less invasive and less burdening alternative to open surgical repair. We hypothesize that EVAR may become the treatment method of choice among elderly patients. During a 7-year-period, EVAR was performed in 654 patients at our institution. One hundred fifty seven (20 %) of these patients were older than 75 years. Our prospectively acquired database was reviewed with respect to midterm results of this elderly population. Aneurysm-related events (aneurysm-related death, endoleaks, conversion, renal infarction or aneurysm rupture) and secondary interventions were the main study endpoints. There were significantly (p < 0.05) higher endoleackage-, conversion and renal infarction rates among this subgroup of patients. In addition, aneurysm related morbidity and mortality were significantly elevated (p = 0.0011). The discussion about early operation at younger age and smaller aneurysm diameter continues. Nevertheless, improved EVAR devices and surgeon experience may make improve future results. Elective endovascular repair failed to demonstrate any benefit in elderly patients (> 75 yrs.) in the midterm outcome. In rupture, this procedure might be the treatment method of choice for patients in this age group who meet specific anatomical criteria.