Document Detail


Endovascular aneurysm repair in nonagenarians is safe and effective.
MedLine Citation:
PMID:  21050985     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Advanced age is a significant risk factor that has traditionally steered patients away from open aneurysm repair and toward expectant management. Today, however, the reduced morbidity and mortality of aortic stent grafting has created a new opportunity for aneurysm repair in patients previously considered too high a risk for open surgery. Here we report our experience with endovascular aneurysm repair (EVAR) in nonagenarians.
METHODS: Retrospective chart review identified all patients>90-years-old undergoing EVAR over a 9-year period at our institution. Collected data included preoperative comorbidities, perioperative complications, endoleaks, reinterventions, and long-term survival.
RESULTS: 24 patients underwent EVAR. The mean age was 91.5 years (range 90-94) among 15 (63%) males and 9 (37%) females. Mean abdominal aortic aneurysm diameter was 6.3±1.1 cm. Eight patients (33%) were symptomatic (pain or tenderness). There were no ruptures. Fourteen patients (58%) had general anesthesia while 10 (42%) had local or regional anesthesia. Mean postoperative length of stay was 3.2±2.4 days (2.8±1.9 days for asymptomatic vs 4.1±3.2 days for symptomatic, P=.29). There was one perioperative mortality (4.2%). There were two local groin seromas (8.3%) and six systemic complications (25%). One patient required reintervention for endoleak (4.2%). There were no aneurysm related deaths beyond the 30-day postoperative period. Mean survival beyond 30 days was 29.7±18.0 months for patients expiring during follow-up. Cumulative estimated 12, 24, and 36-month survival rates were 83%, 64%, and 50%, respectively. Linear regression analysis demonstrated an inverse relationship between the number of preoperative comorbidities and postoperative survival in our cohort (R2=0.701), with significantly decreased survival noted for patients presenting with >5 comorbidities. Those still alive in follow-up have a mean survival of 36.1±16.0 months.
CONCLUSION: This is the largest reported EVAR series in nonagenarians. Despite their advanced age, these patients benefit from EVAR with low morbidity, low mortality, and mean survival exceeding 2.4 years. Survival appears best in those patients with ≤5 comorbidities. With or without symptoms, patients over the age of 90 should be considered for EVAR.
Authors:
Lee J Goldstein; Joshua A Halpern; Combiz Rezayat; Katherine A Gallagher; Elliot B Sambol; Harry L Bush; John K Karwowski
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-05     Completed Date:  2010-12-10     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1140-6     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery, The DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami Jackson Memorial Medical Center, Miami, FL, USA.
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MeSH Terms
Descriptor/Qualifier:
Age Factors
Aged, 80 and over
Aortic Aneurysm, Abdominal / mortality,  surgery*
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation* / adverse effects,  instrumentation,  mortality
Comorbidity
Endovascular Procedures* / adverse effects,  instrumentation,  mortality
Female
Humans
Kaplan-Meier Estimate
Linear Models
Male
New York City
Odds Ratio
Patient Selection
Prosthesis Design
Prosthesis Failure
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Stents
Time Factors
Treatment Outcome
Comments/Corrections
Comment In:
J Vasc Surg. 2010 Nov;52(5):1146   [PMID:  21050986 ]

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