Survival After EVAR in Octogenarians is Similar to the General Population of Octogenarians Without an Abdominal Aortic Aneurysm

Abstract

Introduction: Long-term survival after endovascular aortic aneurysm repair (EVAR) in octogenarians remains unclear. We evaluated this by comparing octogenarians after EVAR with a matched group of octogenarians without an abdominal aortic aneurysm (AAA) from the Rotterdam Study (RS). We also studied the influence of complications after EVAR on survival and aimed to identify risk factors for the development of complications in octogenarians. Methods: Using propensity score matching (PSM), we matched 83 EVAR octogenarians on comorbidities with 83 octogenarians from the RS and compared survival between these two groups using Cox proportional hazard analysis. Then, we studied complications, defined as cardiac or pulmonary, renal deterioration, access site bleeding, acute limb ischemia or bowel ischemia, within 30 days of surgery between 83 EVAR octogenarians and 475 EVAR nonoctogenarians. Also, we studied the difference in baseline characteristics between the octogenarians with and without complications after EVAR and compared survival between the RS controls and the complicated and uncomplicated EVAR octogenarians separately. Results: The total EVAR octogenarian population did not show an increased mortality risk compared to RS octogenarian controls (hazard ratio (HR) 1.18, 95% confidence interval (CI): 0.78- 1.78). Postoperative complications occurred in 23 octogenarians (27.7%) and 59 nonoctogenarians (12.5%, p < 0.0001), mainly due to the occurrence of cardiac (15.7% versus 4.9%, p< 0.0001), pulmonary (4.8% versus 1.3%, p=0.03) and bleeding (6.0% versus 1.9%, p=0.03) complications. Peripheral artery disease (PAD) was the only baseline characteristic that was significantly more prevalent in the complicated EVAR octogenarians compared to the uncomplicated EVAR octogenarians (26.1% versus 8.5%, p=0.04). After uncomplicated EVAR, octogenarians had a similar survival compared to the RS controls (HR 0.99, 95% CI: 0.62-1.58), but after complicated EVAR their mortality risk increased significantly (HR 1.86, 95% CI: 1.02- 3.39). Conclusion: After standard EVAR, the life expectancy of octogenarians equals that of a matched group from the general population without an AAA, provided that they do not develop early postoperative complications. Patient selection and meticulous peri-operative care is key. Disclosure: Nothing to disclose