James Wigley1, Saran Shantikumar2, Waseem Hameed3, Kathryn Griffin4, Ashok Handa3, D Julian A Scott5. 1. Department of Surgery, University Hospital Southampton, Southampton, UK. 2. Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK; Division of Health Sciences, University of Warwick Medical School, Coventry, UK. 3. Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK. 4. Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 5. Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: d.j.a.scott@leeds.ac.uk.
Abstract
BACKGROUND: Endovascular aortic aneurysm repair (EVAR) has been associated with a reduction in early morbidity and mortality compared with open surgery, creating an opportunity for aneurysm repair in those previously considered unfit for intervention. We determine the published incidence of complications and survival after elective EVAR in nonagenarians. METHODS: A systematic literature search was performed using the PubMed, EMBASE, and Cochrane databases up to December 2012. Two observers independently screened search results and extracted data. RESULTS: Six retrospective reports were identified including 361 patients (81% men) with a mean age of 91.6 years. The mean aneurysm size was 69 mm. Comorbidities include hypertension (81%), ischemic heart disease (50%), peripheral vascular disease (30%), and chronic obstructive pulmonary disease (20%). There was no intraoperative mortality, 22% of patients had perioperative medical or surgical complications, and 24% had endoleaks. Mean duration of hospital stay was 4 days. Thirty-day mortality was 5%, and survival at 1, 3, and 5 years was 82%, 56%, and 17%, respectively. CONCLUSIONS: Although the complication rates and longer term survival after elective EVAR in carefully selected nonagenarians appear acceptable, they are higher than those reported in younger patients. Given the typical life expectancy, careful consideration should be given to individual cases before undertaking EVAR in the nonagenarian.
BACKGROUND:Endovascular aortic aneurysm repair (EVAR) has been associated with a reduction in early morbidity and mortality compared with open surgery, creating an opportunity for aneurysm repair in those previously considered unfit for intervention. We determine the published incidence of complications and survival after elective EVAR in nonagenarians. METHODS: A systematic literature search was performed using the PubMed, EMBASE, and Cochrane databases up to December 2012. Two observers independently screened search results and extracted data. RESULTS: Six retrospective reports were identified including 361 patients (81% men) with a mean age of 91.6 years. The mean aneurysm size was 69 mm. Comorbidities include hypertension (81%), ischemic heart disease (50%), peripheral vascular disease (30%), and chronic obstructive pulmonary disease (20%). There was no intraoperative mortality, 22% of patients had perioperative medical or surgical complications, and 24% had endoleaks. Mean duration of hospital stay was 4 days. Thirty-day mortality was 5%, and survival at 1, 3, and 5 years was 82%, 56%, and 17%, respectively. CONCLUSIONS: Although the complication rates and longer term survival after elective EVAR in carefully selected nonagenarians appear acceptable, they are higher than those reported in younger patients. Given the typical life expectancy, careful consideration should be given to individual cases before undertaking EVAR in the nonagenarian.