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
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.
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.
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).
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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