SAVS - Low Mortality in Elective and Emergency Abdominal Aortic Aneurysm Repair in Octogenerians

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Low Mortality in Elective and Emergency Abdominal Aortic Aneurysm Repair in Octogenerians
Christopher M Lamb¹, Katie Rollins¹, Olivia Mitchell¹, David Dawson², Bruce Braithwaite¹, Sadhana Chandrasekar³
¹Queen's Medical Centre, Nottingham, United Kingdom²UC Davis Medical Center, Sacramento, CA;³Tan Tock Seng Hospital, Singapore, Singapore

Introduction
Abdominal aortic aneurysm (AAA) repair in octogenarians is thought to be associated with excess mortality, but an increasing number of patients fall into this group. We sought to establish mortality rates for elective and emergency repair by open and endovascular techniques in our centre.
Methods
Data from consecutive patients aged 80 or over undergoing AAA repair between April 2005 and January 2014 was examined. Aneurysms were classed as either ruptured, symptomatic, or elective. Demographics, procedure type, 30 day mortality and overall survival rates were recorded and analysed.
Results
Ruptured AAAs were repaired in 65 patients (median age 83 years, 53 males). Open repair (OSR) was performed in 32.3% (n=21) and endovascular repair (EVAR) in 67.7% (n=44). Combined 30 day mortality was 35.4% (n=23), and was significantly higher after OSR (52.4% vs. 27.3% p=0.048). Median survival was 6 months (Interquartile range 0 - 22), increasing to 19 months (IQR 6-42) when mortalities within 30 days were excluded. Median survival in patients who lived longer than 30 days was significantly higher in those who had undergone OSR (42.5 vs. 11 months; p=0.019).
Symptomatic AAAs were repaired in 30 patients (median age 84.5, 23 males). OSR was performed in 3.3% (n=1) and 96.7% (n=29) underwent EVAR. Thirty day mortality was 3.3% (n=1); the only death was in the EVAR group. Median survival was 29 months (IQR 5 - 36.5).
Elective AAA repair was performed in 131 patients (median age 82, 116 males); EVAR in 81.7% (n=107) and OSR in 18.3% (n=24). Combined 30-day mortality was 2.3% (n=3) with no significant difference between EVAR and OSR (1.9% vs. 4.2%, p=0.458). Median survival of all patients undergoing elective repair was 19 months (IQR 10-35). No difference was seen between EVAR and OSR groups; p=0.113).
Conclusions
In this cohort of patients, AAA repair in both elective and emergency settings was associated with low mortality and good survival rates in the medium term. For ruptured AAA, 30 day mortality rates are significantly lower in those undergoing EVAR but beyond 30 days, OSR is associated with significantly increased survival. No significant difference between EVAR and OSR was seen in 30 day mortality rate or medium term survival in elective patients.

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SAVS Main Site Annual Meeting Program and Abstracts Past & Future Meetings		Back to 2015 Annual Meeting Abstracts Low Mortality in Elective and Emergency Abdominal Aortic Aneurysm Repair in Octogenerians Christopher M Lamb¹, Katie Rollins¹, Olivia Mitchell¹, David Dawson², Bruce Braithwaite¹, Sadhana Chandrasekar³ ¹Queen's Medical Centre, Nottingham, United Kingdom²UC Davis Medical Center, Sacramento, CA;³Tan Tock Seng Hospital, Singapore, Singapore Introduction Abdominal aortic aneurysm (AAA) repair in octogenarians is thought to be associated with excess mortality, but an increasing number of patients fall into this group. We sought to establish mortality rates for elective and emergency repair by open and endovascular techniques in our centre. Methods Data from consecutive patients aged 80 or over undergoing AAA repair between April 2005 and January 2014 was examined. Aneurysms were classed as either ruptured, symptomatic, or elective. Demographics, procedure type, 30 day mortality and overall survival rates were recorded and analysed. Results Ruptured AAAs were repaired in 65 patients (median age 83 years, 53 males). Open repair (OSR) was performed in 32.3% (n=21) and endovascular repair (EVAR) in 67.7% (n=44). Combined 30 day mortality was 35.4% (n=23), and was significantly higher after OSR (52.4% vs. 27.3% p=0.048). Median survival was 6 months (Interquartile range 0 - 22), increasing to 19 months (IQR 6-42) when mortalities within 30 days were excluded. Median survival in patients who lived longer than 30 days was significantly higher in those who had undergone OSR (42.5 vs. 11 months; p=0.019). Symptomatic AAAs were repaired in 30 patients (median age 84.5, 23 males). OSR was performed in 3.3% (n=1) and 96.7% (n=29) underwent EVAR. Thirty day mortality was 3.3% (n=1); the only death was in the EVAR group. Median survival was 29 months (IQR 5 - 36.5). Elective AAA repair was performed in 131 patients (median age 82, 116 males); EVAR in 81.7% (n=107) and OSR in 18.3% (n=24). Combined 30-day mortality was 2.3% (n=3) with no significant difference between EVAR and OSR (1.9% vs. 4.2%, p=0.458). Median survival of all patients undergoing elective repair was 19 months (IQR 10-35). No difference was seen between EVAR and OSR groups; p=0.113). Conclusions In this cohort of patients, AAA repair in both elective and emergency settings was associated with low mortality and good survival rates in the medium term. For ruptured AAA, 30 day mortality rates are significantly lower in those undergoing EVAR but beyond 30 days, OSR is associated with significantly increased survival. No significant difference between EVAR and OSR was seen in 30 day mortality rate or medium term survival in elective patients. Back to 2015 Annual Meeting Abstracts
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