Outcomes of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians

Abstract

We set out to present the late 3-year performance of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians by the chimney/snorkel technique. At one center, between January 2009 and December 2014, chimney/snorkel technique-endovascular aortic aneurysm repair was performed in 35 high-risk unfit-for-open-repair octogenarian patients with juxtarenal aortic aneurysms. Twenty-five patients were asymptomatic (71.4%), and 10 patients were treated in an urgent care setting. The median follow-up was 36months (range, 1-69). The primary endpoint was the survival rate. Technical success was 100%. A single chimney-graft placement was performed in 22 patients (62.9%), double chimneys in 10 patients (28.6%), and triple chimneys were performed in 3 (8.5%) patients. Overall, 51 renovisceral vessels (22 right renal arteries, 23 left renal arteries, and 6 superior mesenteric arteries) were involved. The thirty-day mortality rate was 2.9% (n= 1). Early morbidity was 14.3%, predominantly due to access-related complications. Major adverse events were observed in 5.7% (n= 2) of the present cohort. No early reinterventions for endoleaks were registered. The midterm reintervention rate was 12.1% due to type Ib endoleak (n= 1), type II endoleak (n= 1), and high-grade chimney-graft stenosis (n= 2). Estimated survival was 91.9% at 1year and 72.8% at 3years. Freedom from reintervention at 1 and 3years was 94% and 91%, respectively. Juxtarenal aortic aneurysm treatment with chimney/snorkel technique-endovascular aortic aneurysm repair in octogenarians is associated with low perioperative mortality and morbidity as well as acceptable midterm survival and secondary procedures.