Aortic Aneurysm Repair In Octogenarians Research Articles

Procedural and long-term outcomes of elective endovascular abdominal aortic aneurysm repair in octogenarians

Procedural and long-term outcomes of elective endovascular abdominal aortic aneurysm repair in octogenarians

Procedural and long-term outcomes of elective endovascular abdominal aortic aneurysm repair in octogenarians

The aim of the study was to compare the immediate and long-term outcomes of endovascular aneurysm repair (EVAR) between patients under and over the age of 80 with abdominal aortic aneurysm (AAA). From 2011 to 2017, we conducted a retrospective cohort study with AAA patients who received elective EVAR. Primary outcomes included hospital mortality, length of stay, acute kidney injury, and the need for re-interventions. Secondary outcomes included aneurysm-related mortality, acute myocardial infarction, stroke, acute limb ischemia, and prolonged mechanical ventilation. A total of 77 (62.6%) patients under the age of 80 years old and 46 (37.4%) octogenarians were included in the study. The male gender and AAA diameter did not differ among groups (92.2% vs. 82.6%, p = 0.11 and 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectively). The younger patients had a higher prevalence of tobacco use (72.7% vs. 41.7%, p = 0.01). There were no deaths during the index hospitalization. The incidence of reinterventions (5.3% vs. 15.2%, p = 0.11) and acute kidney injury (14.3% vs. 23.9%, p = 0.18) did not differ between groups, but the length of stay was longer for octogenarian patients (3 days [2-4] vs. 2 days [2-3, p = 0.04)]. Endoleaks were the most common cause for re-interventions (81.8%), with a prevalence of 34% across the entire cohort. There were no differences in any of the secondary outcomes between groups. In octogenarian patients with AAA, EVAR represents a safe procedure both during the index hospitalization and during long-term follow-up.

Local Anesthesia for Endovascular Aortic Aneurysm Repair in Octogenarians Can Reduce Hospital Stay With Fewer Postoperative Respiratory Complications

Local Anesthesia for Endovascular Aortic Aneurysm Repair in Octogenarians Can Reduce Hospital Stay With Fewer Postoperative Respiratory Complications

Fenestrated endovascular abdominal aortic aneurysm repair in octogenarians is associated with higher mortality and an increased incidence of nonhome discharge

Objective: Fenestrated endovascular abdominal aortic aneurysm repair (FEVAR) has been increasingly becoming the endovascular treatment of choice for patients with juxtarenal abdominal aortic aneurysms with an infrarenal neck, not suitable for traditional endovascular abdominal aortic aneurysm repair. Older patients are at a high risk of developing complications after elective procedures. A review of the literature showed mixed results for FEVAR in the elderly patient population. In the present study, we investigated the occurrence of mortality (both short and long term), discharge destination, and other postoperative outcomes in the octogenarian population who had undergone FEVAR for the management of abdominal aortic aneurysms in a large, national surgical database.

Fenestrated endovascular abdominal aortic aneurysm repair in octogenarians is associated with higher mortality and an increased incidence of nonhome discharge

ObjectiveFenestrated endovascular abdominal aortic aneurysm repair (FEVAR) has been increasingly becoming the endovascular treatment of choice for patients with juxtarenal abdominal aortic aneurysms with an infrarenal neck, not suitable for traditional endovascular abdominal aortic aneurysm repair. Older patients are at a high risk of developing complications after elective procedures. A review of the literature showed mixed results for FEVAR in the elderly patient population. In the present study, we investigated the occurrence of mortality (both short and long term), discharge destination, and other postoperative outcomes in the octogenarian population who had undergone FEVAR for the management of abdominal aortic aneurysms in a large, national surgical database. MethodsA retrospective analysis of patients who had undergone FEVAR in the Society for Vascular Surgery Vascular Quality Initiative database was performed from July 2010 to June 2019. The study cohort excluded patients aged <18 years and concomitant procedures for snorkeling of visceral branches of the aorta. The final selected cohort was divided into two patient groups: group I, patients aged <80 years (nonoctogenarians); and group II, patients aged ≥80 years (octogenarians). The primary outcomes were mortality at 30 days (short term), 6 months, and 1 year (long term) and the discharge destination. The secondary outcomes included postoperative length of stay, intensive care unit stay, postoperative major cardiac events, and the need for intervention. Computation of models to measure the outcomes and identify the risk factors contributing to mortality at 30 days and discharge to a nonhome destination was performed using multiple logistic regression analyses. Cox proportional hazards regression analysis was performed to study the long-term mortality in the patient groups. ResultsA total of 5507 patients had undergone FEVAR in the 9-year period in the Society for Vascular Surgery Vascular Quality Initiative database (group I, nonoctogenarians, n = 4424 [80.3%]; group II, octogenarians, n = 1156 [19.7%]). Octogenarians were more likely to be women, white, Medicare insured, and hypertensive. This group also had lower rates of former or current smokers, a lower glomerular filtration rate, a lower incidence of late-stage chronic kidney disease, and an aneurysm diameter >5.5 cm. Greater estimated blood loss and longer procedures were also noted in the octogenarian group compared with the nonoctogenarian group. Multiple logistic regression analysis showed that octogenarians had had greater mortality at 30 days (7.3%; adjusted odds ratio [aOR], 1.21; 95% confidence interval [CI], 1.0-1.45; P = .044), 6 months (13.7%; aOR, 1.52; 95% CI, 1.24-1.81; P < .001), and 1 year (17.5%; aOR, 1.67; 95% CI, 1.34-2.07; P < .001). The present analysis to measure the discharge destination showed that octogenarians had a greater risk of discharge to nonhome destinations (26.7%; aOR, 1.50; 95% CI, 1.24-1.81; P < .001). Octogenarians had a lower risk of ≥2 days of an intensive care unit stay (aOR, 0.76; 95% CI, 0.67-0.91; P < .001) but a greater risk of experiencing dysrhythmia (10.1%; aOR, 1.32; 95% CI, 1.01-7.1; P = .036) following the procedure compared with the nonoctogenarians. ConclusionsIn our retrospective analysis of a large, national surgical database, we found that of the patients undergoing FEVAR to manage juxtarenal abdominal aortic aneurysms, octogenarians had greater mortality and a greater risk of being discharged to nonhome locations compared with nonoctogenarians.

Outcomes Justify the Use of Branched and Fenestrated Endovascular Devices for Aortic Aneurysm Repair in Octogenarians

We compared the outcomes between patients aged ≥80 years and patients aged <80 years undergoing thoracoabdominal and juxtarenal aortic aneurysm repair using branched and/or fenestrated endovascular devices (B/FEVAR).

Outcomes after Elective Open Abdominal Aortic Aneurysm Repair in Octogenarians Compared to Younger Patients in Korea.

BackgroundAlthough the first choice of treatment for abdominal aortic aneurysm (AAA) is endovascular aneurysm repair, especially in elderly patients, some patients require open surgical repair. The purpose of this study was to compare the mortality outcomes of open AAA repair between octogenarians and younger counterparts and to identify the risk factors associated with mortality.MethodsAll consecutive patients who underwent elective open AAA repair due to degenerative etiology at a single tertiary medical center between 1996 and June 2020 were included in this retrospective review. Medical records and imaging studies were reviewed to collect the following information: demographics, comorbid medical conditions, clinical presentations, radiologic findings, surgical details, and morbidity and mortality rates. For analysis, patients were divided into two groups: older and younger than 80 years of age. Multivariate analysis was performed to identify factors associated with mortality after elective open AAA repair.ResultsAmong a total of 650 patients who underwent elective open AAA repair due to degenerative AAA during the study period, 58 (8.9%) were octogenarians and 595 (91.1%) were non-octogenarians. Patients in the octogenarian group were predominantly female and more likely to have lower body weight and body mass index (BMI), hypertension, chronic kidney disease, and lower preoperative serum hemoglobin and albumin compared with patients in the non-octogenarian group. Maximal aneurysm diameter was larger in octogenarians. During the median follow-up duration of 34.4 months for 650 patients, the median length of total hospital and intensive care unit stay was longer in octogenarians. The 30-day (1.7% vs. 0.7%, P = 0.374) and 1-year (6.9% vs. 2.9%, P = 0.108) mortality rates were not statistically significantly different between the two groups. Multivariate analysis showed that low BMI was associated with increased 30-day (odds ratio [OR], 16.339; 95% confidence interval [CI], 1.192–224.052; P = 0.037) and 1-year (OR, 8.236; CI, 2.301–29.477; P = 0.001) mortality in all patients.ConclusionBecause the mortality rate of octogenarians after elective open AAA repair was not significantly different compared with their younger counterparts, being elderly is not a contraindication for open AAA repair. Low BMI might be associated with increased postoperative mortality.

Outcomes of Elective Endovascular Aortic Aneurysm Repair in Octogenarians

Outcomes of Elective Endovascular Aortic Aneurysm Repair in Octogenarians

Ruptured Abdominal Aortic Aneurysms: Should We Palliate on Age?

Roosendaal et al.1Roosendaal L.C. Kramer G.M. Wiersema A.M. Wisselink W. Jongkind V. Outcome of ruptured abdominal aortic aneurysm repair in octogenarians: a systematic review and meta-analysis.EJVES. 2019; 59: 16-22Google Scholar conducted an up to date meta-analysis of mortality outcomes following ruptured abdominal aortic aneurysm (rAAA) in the over 80s, totalling 7 526 patients. The pooled results of eight studies identified an overall mortality rate of 43% at 30 days (27% endovascular aneurysm repair (EVAR), 52% open) with a significant advantage of EVAR over open repair. In addition, four studies totalling 2 550 patients reported one year mortality of 47%, also with a relative risk of 0.65 between EVAR and open. The overall mortality rates in this study were evaluated against those from randomised controlled trials (RCTs), which are indeed comparable (38.6% for EVAR and 42.8% for open repair);2Sweeting M.J. Ulug P. Powell J.T. Desgranges P. Balm R. Ruptured Aneurysm TriallistsRuptured aneurysm trials: the importance of longer-term outcomes and meta-analysis for 1-year mortality.EJVES. 2015; 50: 297-302Google Scholar however as these patients were not randomised the studies are likely to have included more unstable patients (which were not included in all of the RCTs), and all patients had a confirmed ruptured AAA, which was only the case in 87% of patients in the IMPROVE trial.3Powell J.T. Sweeting M.J. Thompson M.M. Ashleigh R. Bell R. et al.IMPROVE trial investigatorsEndovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial.BMJ. 2014; 348: f7661Crossref PubMed Scopus (318) Google Scholar Inclusion of more unstable patients could explain the significant difference between EVAR and open outcomes by effectively comparing a more and a less stable cohort. In addition, unstable patients will preclude computed tomography scanning (and therefore EVAR) and are likely to have a lower survival, worsening the overall survival for open repair. As the studies included in this meta-analysis were not randomised the results should ideally be compared with other non-randomised studies in order to identify any difference that could be attributed to age. The summary data from the European Society for Vascular Surgery (ESVS) aorto-iliac aneurysm guidelines identifies a peri-operative mortality of 26.8% for EVAR and 39.6% for open repair across 12 studies and over 120 000 patients.4Wanhainen A. Verzini F. Van Herzeele I. Allaire E. Bown M. Cohnert T. European society of vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms.EJVES. 2019; 57: 8-93Google Scholar The studies included in the ESVS guidelines are less contemporary than this meta-analysis, with only 14% undergoing EVAR, compared with 35% in this meta-analysis, highlighting the age of these studies. Despite this, the results in octogenarians are poorer than across all ages. The difficulty in this condition is that the mortality rate without any intervention is approaching 100%; therefore, although outcomes may be poorer in octogenarians, they remain superior to no intervention. This study also highlights the lack of patient related outcome measures following ruptured AAA repair. The authors attempted to assess ambulatory status which was not reported; however, future consideration of other health related quality of life measures such as place of residence, carers, and general quality of life measures should be assessed. In addition, little has been reported regarding long term mortality outcomes, or indeed complications in patients undergoing ruptured AAA repair. The results of this meta-analysis highlight the importance of selecting patients based on their overall health, as appropriately selected patients can have reasonable outcomes, and age should remain as an important part of the decision making process. Outcome of Ruptured Abdominal Aortic Aneurysm Repair in Octogenarians: A Systematic Review and Meta-AnalysisEuropean Journal of Vascular and Endovascular SurgeryVol. 59Issue 1PreviewThis meta-analysis sought to identify the mortality and ambulatory state 30 days and one year post-operatively in octogenarians treated for ruptured abdominal aortic aneurysm (rAAA) by endovascular aneurysm repair (EVAR) or open repair (OR). rAAA is a life threatening emergency occurring increasingly in octogenarians. Surgical treatment, open or endovascular, offers the only chance of survival albeit with significant mortality and morbidity rates and a high burden to society. In order to make an informed decision on management, contemporary treatment outcomes should be known. Full-Text PDF Open Archive

Long-term outcomes comparing endovascular and open abdominal aortic aneurysm repair in octogenarians

ObjectivePatients older than 80 years have significantly lower early mortality with endovascular aneurysm repair (EVAR) compared with open repair for abdominal aortic aneurysms (AAAs), but long-term results remain poorly studied. We analyzed the results of both emergent and elective AAA repair in patients aged 80 years or older who had at least 5 years of follow-up. MethodsRetrospective review of a prospectively collected vascular surgery database was performed to identify all patients who underwent elective repair of an AAA between 2007 and 2012 and were 80 years of age or older at the time of surgery. Open and EVAR groups were compared using univariate statistics. ResultsThe study cohort was composed of 314 patients 80 years of age or older (median, 83 years; interquartile range, 5 years) who underwent repair (96 open, 218 EVAR). The groups had similar comorbidities, except that EVAR patients were more likely to be male and open repair patients were more likely to have larger aneurysms. Compared with open repair, elective early postoperative mortality was significantly lower for EVAR patients (1% vs 14%; P < .001). Overall mean life expectancy was 5.9 years (EVAR, 5.8 years; open repair, 5.8 years; P = .98). The 1-year survival was significantly higher for EVAR (92.9%) than for open repair (84.1%; P = .02). The 2-year survival (EVAR, 83.4%; open repair, 74.6%; P = .07) and 5-year survival (EVAR, 57.8%; open repair, 60.3%; P = .98) did not differ between EVAR and open repair. Reintervention rates (EVAR, 18%; open repair, 2%; P = .05) were higher in the endovascular treatment group. ConclusionsEVAR results in an improved 1-year mortality in octogenarians compared with open repair, although 5-year survival is similar between the groups. With average life expectancies of >5 years and an 18% reintervention rate, diligent follow-up is required after EVAR even in elderly patients.

Predictors of acute kidney injury after infrarenal abdominal aortic aneurysm repair in octogenarians

ObjectiveAcute kidney injury (AKI) is a common postoperative complication after abdominal aortic aneurysm (AAA) repair and is associated with significant morbidity and mortality. However, limited studies have investigated this complication in elderly patients. This study aims to evaluate AKI in octogenarians after open endovascular AAA repair (OAR) and endovascular AAA repair (EVAR). MethodsData were obtained from the Vascular Quality Initiative database on all patients who underwent elective infrarenal AAA repair between January 2003 and April 2017. Univariate analysis was used to compare AKI rates as well as failure to rescue after AKI between octogenarians and nonoctogenarians in OAR and EVAR. Stepwise multivariable logistic regression analysis was implemented to identify independent predictors and develop a risk calculator of AKI in octogenarians undergoing AAA repair. ResultsA total of 27,993 patients (12% OAR and 88% EVAR) were included, of which 6708 (24%) were octogenarians (OAR, 332; EVAR, 6376). Postoperative AKI was more common in octogenarians as compared with nonoctogenarians in OAR (15.1% vs 10.1%; P = .01) and EVAR (4.2% vs 2.7%; P < .001). Similarly, failure to rescue, defined as 30-day mortality after postoperative AKI, was higher in octogenarians whether undergoing OAR (28.0% vs 8.8%; P < .001) or EVAR (14.1% vs 7.5%; P < .01). On multivariable analysis, octogenarians undergoing OAR had a 3.5 times higher odds of AKI compared with those undergoing EVAR (odds ratio [OR], 3.52; 95% confidence interval [CI], 2.36-5.23; P < .001). Other independent risk factors for postoperative AKI in octogenarians included chronic obstructive pulmonary disease (OR, 1.48; 95% CI, 1.14-1.93), chronic kidney disease stage III (OR, 2.17; 95% CI, 1.26-3.76) and chronic kidney disease stage IV-V (OR, 5.7; 95% CI, 3.0-10.9), peripheral artery disease (OR, 1.99; 95% CI, 1.34-2.94), preoperative β-blocker use (OR, 1.85; 95% CI, 1.45-2.38), and aneurysm diameter (OR, 1.25; 95% CI, 1.11-1.41). These predictors were incorporated in an interactive risk calculator of AKI after AAA repair in octogenarians (C-statistic = 0.728). ConclusionsAKI is a serious complication after AAA repair, especially in octogenarians, and is associated with high failure to rescue rates. A careful assessment of risk factors for AKI in elderly patients should be performed to inform clinical decision making.

Long-term Outcomes Comparing Endovascular and Open Abdominal Aortic Aneurysm Repair in Octogenarians

Long-term Outcomes Comparing Endovascular and Open Abdominal Aortic Aneurysm Repair in Octogenarians

PC018. Long-Term Outcomes Comparing Endovascular and Open Abdominal Aortic Aneurysm Repair in Octogenarians

Patients 80 years or older have significantly lower early mortality with endovascular aortic aneurysm repair (EVAR) when compared with open repair for abdominal aortic aneurysms (AAA). The long-term results in this older patient population remain poorly studied. We analyzed the results of emergent and elective AAA repair in patients 80 years or older who had at least 5 years of follow-up. A retrospective review of a prospectively collected vascular surgery database at a university-affiliated medical center was performed to identify all patients who underwent repair of an AAA between 2007 and 2012 and were 80 years of age or older at the time of surgery. Open and EVAR groups were compared for outcomes using univariate statistics. The study cohort comprised 314 patients (mean age, 83.5 ± 2.9 years) who underwent repair (96 open repair, 218 EVAR). Patients treated with open repair and EVAR had similar comorbidities, except that EVAR patients were more likely to be male, and open repair patients were more likely to have larger aneurysms. When compared with open repair, elective early postoperative mortality was significantly lower for EVAR patients (1% vs 14%; P < .001). Overall mean life expectancy was 5.9 years (5.8 years EVAR, 5.8 years open repair; P = .98). The 1-year survival was significantly higher for EVAR (92.9%) compared with open repair (84.1%; P = .02). Although 2-year survivals (83.4% EVAR, 74.6% open repair; P = .07), and 5-year survivals (57.8% EVAR, 60.3% open repair; P = .98) did not differ between EVAR and open repair (Fig 1). The most common causes of long-term mortality were malignant disease and cardiovascular events in both groups. Three patients (1.4%) initially treatment by endovascular intervention sustained a mortality related to their aneurysm, and no aneurysm-related mortalities occurred in the open group. Reintervention rates (14% EVAR, 2% open repair; P = .05) were higher in the endovascular treatment group (Fig 2). EVAR results in an improved 1-year mortality in octogenarians when compared with open repair, although 5-year survival is similar between the two groups. With average life expectancies over 5 years after surgery and a 14% reintervention rate, diligent follow-up is required after EVAR in these elderly patients.Fig 2Freedom from reintervention. Cum, Cumulative; EVAR, endovascular aortic aneurysm repair.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Outcomes of endovascular aortic aneurysm repair in octogenarians with hostile iliac artery anatomy

Outcomes of endovascular aortic aneurysm repair in octogenarians with hostile iliac artery anatomy

Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians: Meta-analysis and Systemic Review

This meta-analysis and systematic review aimed to highlight the results of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) to assess safety and effectiveness in patients older than 80 years of age compared with younger patients. PRISMA guidelines were used; quality was appraised, and data were extracted and analysed following the Cochrane collaboration. The MEDLINE and Embase databases were searched on December 31, 2016. All studies related to clinical outcomes following EVAR for AAA treatment in octogenarians compared with those in younger patients were included for a meta-analysis and systematic review of short- and midterm outcomes. Data were analysed using a fixed or random effects model by pooling and calculating odds ratios (ORs) or hazard ratios (HRs) and weighted mean differences, to investigate the safety and feasibility of endoluminal treatment in octogenarians. Published literature search identified nine observational studies, comprising 25,723 patients with AAA (5989 octogenarians and 19,734 younger patients). More males (OR 0.621, p = .002) and smokers (OR 0.457, p < .001) were observed in the younger group. Frequent concomitant diseases were associated with advanced age, thus, the procedural duration, blood loss estimation, and length of stay were considerably higher among octogenarians. Although elderly patients have a higher 30 day mortality (2.7% vs 1.5%, p < .001), endoleak, pulmonary, and renal diseases, no significant difference was found in the technical success of the procedure. As expected, the HR for octogenarians was markedly higher than that of younger patients (HR 1.946, p < .001) for midterm all-cause mortality. However, the re-intervention rate to maximum follow-up period of 5 years was not significantly different (HR 1.148, p = .408) between the groups. Compared with younger patients, EVAR in octogenarians is associated with a significantly higher but still acceptable peri-operative and midterm mortality rate. Because of similar midterm re-intervention rates, these findings suggest that EVAR remains an appropriate therapeutic approach in the elderly group if comprehensive pre-operative evaluation and post-operative surveillance are incorporated.

Abdominal aortic aneurysm repair in octogenarians is associated with higher mortality compared with nonoctogenarians

Age is a well-known independent risk factor for death after abdominal aortic aneurysm (AAA) repair. However, there is significant debate about the utility of AAA repair in older patients. In this study, mortality outcomes after endovascular AAA repair (EVAR) and open AAA repair (OAR) in octogenarians (aged ≥80years) were compared with younger patients (aged<80years). All patients recorded in the Vascular Quality Initiative database (2002-2012) who underwent infrarenal AAA repair were included. Univariable and multivariable statistics were used to compare perioperative (30-day) and 1-year mortality outcomes between octogenarians vs nonoctogenarians for OAR and EVAR. During the study period, 21,874 patients underwent AAA repair (OAR, 5765; EVAR, 16,109), including 4839 octogenarians (OAR, 765; EVAR, 4074) and 17,035 nonoctogenarians (OAR, 5000; EVAR, 12,035). Octogenarians (mean age, 83.0± 0.1years) were less frequently male (66% vs 75%) and had a higher prevalence of congestive heart failure (9.9% vs 7.1%), chronic renal insufficiency (12.2% vs 7.5%), and a history of aortic surgery (14.3% vs 7.7%) compared with nonoctogenarians (P< .01 for all). Intraoperative use of blood transfusions and vasopressors was more common in octogenarians for OAR (blood: 3.3± 4.4 vs 1.8± 3.7 units; vasopressors: 45.2% vs 32.8%) and EVAR (blood: 0.43± 1.7 vs 0.31± 1.6 units; vasopressors: 7.6% vs 5.7%; P< .01 for all). Contrast dye volumes used during EVAR were similar in octogenarians and nonoctogenarians (108± 71 vs 107± 68mL; P= .18). Perioperative mortality after OAR was 20.1% in octogenarians compared with 7.1% in nonoctogenarians (P< .01). Perioperative mortality after EVAR was 3.8% in the octogenarians compared with 1.6% in nonoctogenarians (P< .01). One-year mortality among octogenarians vs nonoctogenarians was 26% vs 9.7% for OAR and 8.9% vs 4.3% for EVAR (log-rank test, P< .01 for both). Multivariable analysis controlling for baseline and intraoperative differences between groups demonstrated that age ≥80years increased the risk of 30-day and 1-year mortality after AAA repair by 223% and 187%, respectively (P< .01 for both). AAA repair should be approached with extreme caution in octogenarians. Perioperative and 1-year mortality rates after OAR are particularly high in the older population, suggesting that the appropriate aneurysm size threshold for OAR might be larger due to the greater operative risk in octogenarian patients.

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.

Low Mortality in Elective and Emergency Abdominal Aortic Aneurysm Repair in Octogenarians

Low Mortality in Elective and Emergency Abdominal Aortic Aneurysm Repair in Octogenarians

Contemporary outcomes of open thoracoabdominal aortic aneurysm repair in octogenarians

We sought to evaluate our contemporary outcomes with open thoracoabdominal aortic aneurysm (TAAA) repair in octogenarians to determine whether open TAAA repair is a viable option, with acceptable risk, in this elderly cohort. We analyzed clinical data from 1267 enrolled patients who underwent open TAAA repair between 2003 and 2013. Eighty-eight patients (7%) were octogenarians (median age, 82 years; range, 80-92 years) and 1179 were 79 years of age or less. Aneurysm rupture was more common in octogenarians (14% vs 4.7%, P=.001), whereas aortic dissections predominated in younger patients (43.9% vs 13%, P<.001). Octogenarians had higher rates of visceral-branch endarterectomy/stenting (58% vs 33.5%, P<.001), adverse postoperative outcomes (36% vs 15.3%, P<.001), operative mortality (26% vs 6.9%, P<.001), and prolonged hospital stay (P=.004). Among octogenarians, preoperative aortic dissection was most commonly associated with extent I repair (42% vs <10% for other extents, P<.001). Extent II repairs most frequently necessitated concomitant visceral-branch procedures and carried the highest risk of mortality (62%). Extent I and III repairs carried intermediate operative risk, and extent IV repairs posed the least risk (11%). Multivariate modeling analysis identified extent II TAAA (P=.001; odds ratio, 11.6), presence of concomitant dissection (P=.02; odds ratio, 5.6), and aneurysm rupture (P=.02; odds ratio, 5.7) as independent predictors of operative mortality in octogenarians. Open extent II TAAA repair carries significant risk for octogenarians; extent I, III, and IV repairs incur more reasonable postoperative risk. Although TAAA repair should not be denied to octogenarians based solely on age, extensive TAAA repair should be performed with caution.

PS44 Functional Status as a Predictor of Mortality in Open and Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians

PS44 Functional Status as a Predictor of Mortality in Open and Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians