Aortic Aneurysms In Octogenarians Research Articles

Emergency Open Surgical Repair for Ruptured Abdominal Aortic Aneurysm in Octogenarians and Nonagenarians: A Single-Center Retrospective Observational Study

In the endovascular aneurysm repair era, open surgical repair (OSR) is performed for ruptured abdominal aorta aneurysm (RAAA) in patients with complex aneurysm neck and technical difficulties. Understanding the risk factors of OSR is essential for the clinical selection of the ideal surgical procedure. We aimed to re-evaluate the outcomes of OSR and treatment options for RAAA. Patients who underwent OSR for RAAA between January 2010 and December 2022 were enrolled in this single-center retrospective observational study. Preoperative status, operative findings, and postoperative course were retrospectively reviewed. The Cox proportional hazards model was used to evaluate the association between age and early postoperative mortality. Among 142 patients, 43 (30.3%) and 99 (69.7%) were aged ≥80 and<80years, respectively. Postoperative mortality within 30days occurred in 24 (16.9%) patients (11/43 [25.6%] and 13/99 [13.1%] patients aged ≥80 and<80years, respectively; hazard ratio=1.95; P=0.069). In a multivariable analysis, increased postoperative mortality within 30days was associated with age ≥80years (adjusted hazard ratio, aHR=2.36; P=0.049), the presence of preoperative or intraoperative cardiopulmonary arrest (aHR=12.0; P<0.001), and postoperative gastrointestinal disorder (aHR=4.42; P=0.003). Endovascular aneurysm repair may be preferable in older people; however, its use in cases of preoperative or intraoperative cardiopulmonary arrest or perioperative gastrointestinal disorders remains controversial, and a careful discussion on the surgical indications is needed in such cases.

Morbidity and Mortality Following Repair of Ruptured Abdominal Aortic Aneurysms in Octogenarians

Morbidity and Mortality Following Repair of Ruptured Abdominal Aortic Aneurysms in Octogenarians

Morbidity and Mortality Following EVAR and Open AAA Repair in Ruptured Abdominal Aortic Aneurysms in Octogenarians

Morbidity and Mortality Following EVAR and Open AAA Repair in Ruptured Abdominal Aortic Aneurysms in Octogenarians

The choice of tactics for surgical treatment of abdominal aortic aneurysm in octogenarians

Currently, the treatment of abdominal aortic aneurysm does not pose significant difficulties, with modern cardiovascular surgery offering the possibility of both open and endovascular repair (EVAR) techniques. However, the personalized selection of the most optimal surgical intervention for each patient remains a relevant question. In some cases, one of the important factors influencing the choice of surgical method is the patient’s age and accompanying diseases. Abdominal aortic aneurysm is an age-related condition with a high risk of fatal outcomes. In our practice, we encountered a rare case of abdominal aortic aneurysm in an octogenarian woman with severe somatic status, poorly controlled arterial hypertension, and complex anatomical enlargement of the aneurysm. The question arose regarding the choice of optimal tactics and surgical treatment method. According to the MSCT, the diameter of the expansion was 67 mm, posing a 20% risk of rupture in the first year. In this clinical case, EVAR technique was unsuitable due to the anatomical features of the aneurysm, as the length of the neck in the infrarenal segment of the aorta was 2.5–3 cm, and the angle of inclination to the right exceeded 85°. Additionally, considering gender-specific factors, particularly female gender, indications for EVAR need to be carefully determined, as women have a higher likelihood of complications following the operation, as shown in several studies. After a detailed analysis of the re-evaluation results and assessment of surgical risk factors, we determined an individual surgical strategy and minimized risks, ultimately achieving a good outcome.

Outcome of elective endovascular repair of abdominal aortic aneurysms in octogenarians.

The need to adjust the indications of elective abdominal aortic aneurysm (AAA) repair among patients with a limited life-span deserves a specific evaluation for octogenarians. The aim of this study was to compare the postoperative results and the long-term survival after endovascular repair of abdominal aortic and/or iliac aneurysms (EVAR) in octogenarians compared with patients under 80 years of age. Retrospective analysis of 241 consecutive patients who underwent an elective EVAR between 2000 and 2017. EVAR was not considered among patients with clear life-limiting conditions. Patients receiving other than commercially standard infra-renal endoprostheses were excluded. Seventy patients (29.0%) were octogenarians. They had a lower rate of active smoking (10.0% vs. 30.4%, P < 0.001) and a higher prevalence of previous cerebrovascular disease (21.4% vs. 11.7%, P = 0.055) than younger patients. Thirty-day/in-hospital complication and mortality rates were not significantly higher among octogenarians when compared with younger patients (24.3% vs. 16.9% and 2.9% vs. 2.4%, respectively). Octogenarians had a lower long-term survival at 1, 3 and 5 years (92.6% vs. 93.3%, 67.7% vs. 78.0% and 39.3% vs. 60.6%, P = 0.039) in the bivariate analysis. However, an age ≥ 80 years per se was not an independent predictor of survival after adjustment for confounding factors. An age above 80 years was not associated with an increased risk of postoperative complications or long-term mortality. Our results suggest that EVAR can be considered in elderly patients without a clear life-limiting condition and with a suitable aneurysm anatomy. Geriatr Gerontol Int 2021; 21: 392-397.

Ruptured Abdominal Aortic Aneurysms in Octogenarians: Are the Outcomes too Dire?

Roosendaal et al.1 report the outcomes of octogenarians after ruptured abdominal aortic aneurysm (rAAA) repair over a five year period in four hospitals in the Netherlands. The main findings were a 12 month survival rate of 50%, with >80% of patients returning home at one year. Interestingly, when comparing open aneurysm repair (OAR) versus endovascular repair (EVAR) in rAAA there was no statistically significant difference in mortality at 30 days and one year.

Endovascular repair of abdominal aortic aneurysm in octogenarians: clinical outcomes and complications.

Endovascular aneurysm repair (EVAR) is associated with decreased perioperative morbidity and mortaliy in comparison with open repair, and thus octagenarians are traditionally offered EVAR given their age and medical comorbidities. The aim of this study was to investigate outcomes and predictors of complications associated with EVAR in octogenarians. We conducted a retrospective chart review of consecutive patients aged 80 years and older who received an EVAR between August 2010 and January 2017 at a single centre in Toronto, Ontario. We conducted univariate comparisons and then completed logistic regression to determine predictors of complications. We used Kaplan-Meier analysis to explore survival times. A total of 154 octogenarians underwent an EVAR during the study period for an infrarenal aneurysm with a mean size of 64.8 (standard deviation [SD] 12.7) mm. The mean age of the patients was 84.1 (SD 3.7) years, and most patients (81%) were men. Eighteen patients presented with a ruptured abdominal aortic aneurysm (AAA). Ninety-five (62%) patients sustained a complication. Fifty percent of patients experienced an intraoperative complication. A majority of these (77%) resulted in an endoleak, with type II endoleaks requiring no further intervenion being the most common (58%, n = 45). The remaining complications (n = 70) occurred postoperatively, with myocardial ischemia (n = 24) and dysrhythmias (n = 10) being the most common. Past aortic surgery (χ2 = 8.62, p = 0.014, Cramer V = 0.27) was found to be a multivariate predictor of complications. Most patients (88%) continued follow-up to an average of 20.9 months. Twenty-one patients (13%) died. Nine of these deaths (43%) occurred during the index admission and involved a ruptured AAA. Past aortic surgery was the only predictor of vascular complications. The mean survival time after EVAR was 57.63 months for patients without events. Endovascular aneurysm repair in octogenarians is a suitable form of therapy with acceptable short- and long-term results in the elective setting. Past aortic surgery was a predictor of complications in this population.

Open repair of descending and thoracoabdominal aortic aneurysms in octogenarians

ObjectiveDespite improved outcomes for open repair of descending thoracic aneurysm (DTA) and thoracoabdominal aortic aneurysm (TAAA), these operations remain challenging in octogenarians. Patients unsuitable for thoracic endovascular aortic repair require open surgery to avoid catastrophic rupture. We analyzed our results for DTA/TAAA repair in these elderly patients. MethodsOur institutional aortic database was queried to identify those ≥80 years old and those <80 years old undergoing open DTA/TAAA repair. Logistic and Cox regression analyses were used to account for confounders and to identify predictors of perioperative and long-term outcomes. ResultsFrom 1997 to 2017, there were 783 patients who underwent open repair of DTA or TAAA; 96 (12.3%) were ≥80 years old. Octogenarians were more likely to be female (P = .018), with chronic pulmonary disease (P = .012), severe peripheral vascular disease (P < .001), and hypertension (P = .025). Degenerative aneurysms were more common among octogenarians (P < .001), whereas chronic and acute dissections were more common among those younger than 80 years (P < .001 for both). Operative mortality was 5.6% and was not negatively affected by advanced age (<80 years, 5.7%; ≥80 years, 5.6%; P = .852). Other than an increased incidence of left recurrent nerve palsy in the younger cohort (<80 years, 6.7%; ≥ 80 years, 1.0%; P = .029), there were no significant differences in the incidence of major postoperative complications. Logistic regression modeling showed that age ≥80 years was not predictive of operative mortality or postoperative complications. A greater percentage of octogenarians had aortic reconstruction with a clamp and sew strategy (85.4% vs 61.6%; P < .001), which led to significantly shorter cross-clamp times in this cohort (26.6 minutes vs 30.7 minutes; P < .004). In octogenarians, the incidence of major postoperative adverse events was associated with extent II aneurysms (odds ratio, 2.6; P < .025). Short- and long-term survival was significantly reduced in octogenarians. ConclusionsIn select octogenarians, open repair of DTA/TAAA can be performed with acceptable risk. A simplified surgical approach may provide the best opportunity for a successful outcome.

Endovascular Repair of Abdominal Aortic Aneurysm in Octogenarians: A Report on Clinical Outcomes

Endovascular Repair of Abdominal Aortic Aneurysm in Octogenarians: A Report on Clinical Outcomes

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

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.

Outcomes of total endovascular treatment of juxtarenal aortic aneurysms in octogenarians

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.

Endovascular Repair of Thoracic Aortic Aneurysms in Octogenarians and Older

Endovascular Repair of Thoracic Aortic Aneurysms in Octogenarians and Older

Thoracic Aortic Aneurysms in Octogenarians: The Results of Open Surgical Repair Using Hypothermic Circulatory Arrest with Antegrade Selective Cerebral Perfusion

Although recent progress has expanded the indications for thoracic aortic surgery to include elderly patients, the procedure remains extremely invasive. We performed a chart review to determine the early and late outcomes of thoracic aortic surgery using hypothermic circulatory arrest (HCA) and antegrade selective cerebral perfusion (ASCP) in octogenarians. Of 79 patients who underwent surgery for thoracic aortic aneurysms from April 2007 through December 2012, 8 patients 80 years or older were selected for analysis. Mean age at the time of surgery was 84.3±1.39 years. The diagnoses were aortic dissection in 5 patients and degenerative thoracic aneurysm in 3 patients. All patients underwent surgery with HCA. The lowest body temperature was 25℃ ASCP was used as an additional brain-protection technique. Emergency operations were performed in 5 patients (62.5%). The mean duration of HCA was 60.4±19.7 minutes, that of aortic cross-clamping time was 143.0±30.4 minutes, and mean pump time was 207.8±44.4 minutes. The hospital mortality rate was 0%. Major postoperative complications occurred in 3 (37.5%) patients: stroke, temporary neurologic dysfunction, and paraparesis in 1 patient each. No patients required temporary dialysis for new-onset renal dysfunction. There were no deaths during the 65-month follow-up period. The early and late outcomes after thoracic aortic surgery at our hospital using HCA with ASCP in octogenarians are acceptable. The operations are performed with an acceptable operative risk, even under emergency situations, including acute aortic dissection.

Outcomes after Open Repair of Ruptured Abdominal Aortic Aneurysms in Octogenarians: A 20-Year, Single-Center Experience

The purpose of this study was to evaluate morbidity, mortality, and survival in octogenarians undergoing open repair of ruptured abdominal aortic aneurysms (RAAAs) in comparison to younger patients. This investigation was a retrospective analysis of a prospectively maintained database from a tertiary referral center. We included all consecutive RAAA patients who underwent open repair from 1990 to 2011. Univariate and multivariate analyses were used to identify predictors of inferior short- and long-term outcomes. Overall, 463 patients were identified, of whom 138 (30%) were octogenarians (group 2), with a mean age of 84 ± 0.47 years. There were 96 (69%) men and 42 women (31%). There were more women in group 2 (31%) compared with the <80-year-old patients of group 1 (14%) (P < 0.001). The 30-day mortality for group 2 was 43.5% compared with 28.0% for group 1 (P < 0.001). Preoperatively, 63% of group 1 patients presented with shock compared with 65% of those in group 2 (P = 0.751). There was no difference between the two groups in terms of preoperative systolic blood pressure (SBP), duration of operation, and intraoperative blood loss (P > 0.05). Median preoperative hemoglobin (P < 0.001) and creatinine (P = 0.031) levels were significantly different between the groups. There was no significant difference between the two groups in terms of postoperative complications and length of hospital stay. Median long-term survival for octogenarians (group 2) was 5.4 years compared with 12.4 years for the younger patient group (group 1) (P < 0.001). Multivariate analysis identified age as an independent predictor of 30-day mortality (odds ratio [OR] = 1.154, 95% confidence interval [CI] 1.037-1.285) and inferior long-term survival (OR = 1.074, 95% CI 1.011-1.141). History of cigarette smoking also predicted worse long-term outcomes (OR = 3.044, 95% CI 1.318-7.032) as did multiorgan failure in the postoperative course (OR = 1.363, 95% CI 1.080-14.130). Advanced age is associated with high surgical mortality; however, for octogenarians surviving surgical repair, long-term outcome is acceptable. Therefore, with responsible decision-making, surgical intervention is justifiable in the elderly. Smoking and multiorgan failure were both predictive of worse survival.

Repair of Ruptured Abdominal Aortic Aneurysm in Octogenarians

Repair of Ruptured Abdominal Aortic Aneurysm in Octogenarians

Endovascular repair of infrarenal aortic aneurysms in octogenarians and nonagenarians

The purpose of this report was to present short and midterm results of endovascular aortic aneurysm repair (EVAR) of infrarenal aortic aneurysms in octogenarians and nonagenarians. Between March 1994 and March 2011, elective EVAR was performed in 967 patients in our institution. This includes 279 patients older than 80 years at the time of the procedure (octogenarians: n = 252, nonagenarians: n = 27). Mean follow-up was 48.4 ± 34.5 months. A retrospective analysis was performed. Survival was calculated using Kaplan-Meier analysis and a survival comparison to patients who underwent EVAR <80 years old (n = 688) was performed. Cox hazard regression analysis was used to assess parameters that influence survival. Technical success was 96% in octogenarians and 85% in nonagenarians. Technical failure in 15 of 279 patients includes primary type I endoleak (n = 6), procedure abortion due to inability to pass the iliac vessels (n = 6), and emergency conversion (n = 3). Thirty-day mortality was significantly higher for patients >80 years old (2.8% vs 1.0%; P = .044). Morbidity rates were 11.5% for octogenarians and 7.4% for nonagenarians with predominately cardiopulmonary complications. High-risk patients >80 years old showed a comparable perioperative mortality rate to low-/medium-risk patients >80 years old (2.9% vs 2.5%;P = .717), but a significantly higher complication rate (22.5% vs 9.2%; P = .0275) and reduced midterm survival with 1-, 3-, and 5-year survival rates of 79% ± SE 7%, 55% ± SE 8%, and 38% ± SE 9% (log-rank test P = .03). In high-risk patients age >80 years old, their age did not influence 30-day mortality (2.5% vs 2.7%; P = .978) and midterm survival. Survival in octogenarians at 1, 3, and 5 years was 87.9 ± SE 2.1%, 70.9 ± SE 3.0%, and 55.6% ± SE 3.5%, respectively. Survival in nonagenarians at 1 and 3 years was 96.3% ± SE 4% and 60.6% ± SE 10.4%. Higher cardiac (hazard ratio [HR], 1.22; P = .038) and renal risk scores (HR, 1.59; P = .0016), chronic obstructive pulmonary disease (HR, 1.56; P = .032), and anemia (HR, 2.1; P < .001) influenced midterm survival. EVAR in octogenarians and nonagenarians is associated with a significantly higher but still low perioperative mortality compared to younger patients. Midterm survival in octogenarians and nonagenarians, although significantly lower than in younger patients, is still acceptable, indicating that age >80 years should not be an exclusion criteria for EVAR. Even high-risk patients >80 years can be treated safely with a low perioperative mortality and comparable midterm outcome to younger high-risk patients.

Repair of Ruptured Abdominal Aortic Aneurysm in Octogenarians

Objective To determine whether advanced age was independently associated with prohibitive surgical risks or impaired long-term prognosis after ruptured aortic aneurysm repair. Design Post-hoc analysis of prospective cohort. Materials Consecutive patients undergoing ruptured aneurysm repair between January 2001 and December 2010 at a tertiary referral centre. Methods Surgical mortality (i.e., <30 days) was compared between octogenarians and younger patients using logistic regression modelling to adjust for suspected confounders and to identify prognostic factors. Long-term survival was compared with matched national populations. Results Sixty of 248 involved patients were octogenarians (24%) and almost all were offered open repair ( n = 237). Surgical mortality of octogenarians was 26.7% (adjusted odds ratio (OR) 2.1; 95% confidence interval (CI), 0.9–5.2) and confounded by cardiac disease. Hypovolaemic shock predicted perioperative death of octogenarians best (OR 5.1; 95%CI, 1.1–23.4; P = 0.037). After successful repair, annual mortality of octogenarians averaged 13.7% vs. 5.2% for younger patients. At 2 years, octogenarian survival was at 94% of the expected ‘normal’ survival in the general population (vs. 96% for younger patients). Conclusions Surgical mortality of ruptured aneurysm repair was not independently related to advanced age but mainly driven by cardiac disease and manifest hypovolaemic shock. An almost normal long-term prognosis of aged patients after successful repair justifies even attempts of open repair, particularly in carefully selected patients.

Endovascular repair of abdominal aortic aneurysms in octogenarians

Endovascular aortic aneurysm repair has emerged as an appealing alternative particularly for patients considered at high risk for open surgery. The aim of this study was to investigate the results of endovascular treatment in patients aged >80 years compared with younger patients.

Elective endovascular and open repair of abdominal aortic aneurysms in octogenarians

Endovascular aortic aneurysm repair (EVAR) is an increasingly popular treatment option for patients with abdominal aortic aneurysms (AAA), although open repair is considered the standard by virtue of its durability. Octogenarians, as a subgroup, may stand to benefit the most by EVAR. The purpose of this study is to review operative results and durability of open AAA repair and EVAR in octogenarians. From May 1996 to August 2006, 150 patients aged >or=80 years underwent elective repair of their infrarenal AAA. Eighty-one underwent EVAR and 69 had open repair. Demographic data, aneurysm specifics, comorbidities, operative morbidity and mortality, intensive care unit and hospital length of stay, and late outcomes were analyzed. In the EVAR group, 27 of 81 (33%) patients died during a mean follow-up of 25 months. In the open repair group, 34 of 69 (49%) patients died during a mean follow-up of 43 months. The median survival time for EVAR was 350 weeks (range, 145-404 weeks) compared with 317 weeks (range, 233-342 weeks) for the open repair group. A Kaplan-Meier log-rank analysis showed no difference in early or long-term survival between EVAR and open repair (P = .13). EVAR was associated with decreased blood loss, decreased length of intensive care unit and hospital stays, and a greater number of patients discharged to home. EVAR and open repair are comparable in safety and efficacy in octogenarians. Operative repair outcomes remain acceptable. Mid- and long-term survival are similar, indicating no survival advantage of one procedure compared with the other.

Endovascular repair of abdominal aortic aneurysm in octogenarians: An analysis based on EUROSTAR data

Endovascular repair of abdominal aortic aneurysm in octogenarians: An analysis based on EUROSTAR data