Laparoscopy versus EVAR for the Treatment of Abdominal Aortic Aneurysms in the Octogenarian

Abstract

Octogenarians are considered at high surgical risk for the treatment of abdominal aortic aneurysms (AAA). The laparoscopic aortic surgery (LAS) and the endovascular treatment (EVAR) are 2 minimum invasive techniques whose objective is to limit the operative traumatism. The objective of this study was to compare our results with short- and medium-term results with these 2 techniques in the octogenarians. Between January 2002 and December 2012, the data of 674 operated consecutive AAA (315 LAS, 172 EVAR, and 187 open surgeries) were collected prospectively. Eighty-seven patients aged ≥80years presenting a favorable anatomy were treated by LAS or EVAR. Twenty-five patients aged ≥85years with a favorable anatomy were excluded because we generally did not propose LAS to them. Statistical analysis compared the demographic data and the results of the 2 groups. The principal criterion of judgment (PCJ) was the combined rate of mortality and severe systemic complications (MSSC) at 30days. An uni/multivariate model was used to determine the factors associated with the occurrence of the PCJ. The data were expressed as means and standard deviations. A P value ≤0.05 was considered significant. Sixty-two patients (90% men, age 81.8±1.4years) were included. There were 31 EVAR and 31 LAS. The 2 groups were comparable concerning the demographic data, the comorbidities, and the aneurysmal anatomies. There was a nonsignificant tendency to higher rates of mortality (9.7 vs. 3.2%, P=0.3) and MSSC at 30days (16.1 vs. 3.2%, P=0.09) in the LAS group. During the operation, LAS was associated with a longer operative time (289±85 vs. 152±57min, P<0.0001), more blood losses (1,073±763 vs. 148±194mL, P<0.0001), and more transfusions (2.0±3.0 vs. 0.9±1.1 units, P=0.048). In the postoperative period, the patients operated by LAS had longer reanimation and hospitalization stays (12.9±13.1 vs. 7.0±2.5days, P=0.02; and 3.3±4.4 vs. 0.6±0.7days, P=0.002; respectively). However, in multivariate analysis, an operative duration >300min was the only variable associated with the PCJ (P=0.05). With a follow-up of 9.0±10.7month, there were 2 reinterventions in the EVAR group, whereas with a follow-up of 38.0±23.9month, no reintervention was observed in the LAS group. In the short run, EVAR significantly reduces the operative traumatism in comparison with LAS in the octogenarian presenting an AAA with a favorable anatomy. However, the choice of the technique is not independently predictive of MSSC at 30days. When a durable repair is desirable, LAS remains a possible option in the octogenarian with a good general condition presenting a favorable aneurysmal anatomy.