Tran K et al. – This study compared outcomes after complex endovascular aneurysm repair (EVAR) and infrarenal EVAR in a cohort of octogenarians. Amongst octogenarians, complex EVAR is associated with higher perioperative mortality compared with infrarenal EVAR. Regardless of abdominal aortic aneurysm complexity, larger aneurysms and chronic kidney disease portends greater risk of late death after EVAR.

Methods

• A single–center retrospective review of octogenarians (≥80 years) treated with elective EVAR for abdominal aortic aneurysms
• Complex treated group was treated with snorkel (Sn–EVAR) or fenestrated (F–EVAR) techniques whereas infrarenal EVAR consisted of aneurysm repair without renovisceral involvement

Results

• A total of 105 patients (69 infrarenal and 36 complex) with mean follow–up of 22 months were eligible for analysis
• In the complex EVAR group, a total of 79 branch grafts (61 renal, 11 celiac, 7 superior mesenteric artery) were placed
• In the complex EVAR group the following results were observed; target vessel patency (98.2 % at latest follow–up), more likely to be male (83.3% vs. 61.1%), higher prevalence of renal insufficiency (72.2% vs. 44.5 %), and significantly common thirty–day mortality (11.0% vs. 0%)
• No significant difference were found in major adverse events or late intervention in both the groups
• Interestingly, sac growth >10 mm was noted to be more frequent with infrarenal EVAR (17.6% vs.2.9%)
• Both type Ia and IIa endoleaks were found equally in both the groups
• At latest follow–up, complex EVAR was not associated with all–cause mortality
• Abdominal aortic aneurysms >75 mm in diameter and renal insufficiency were the only independent risk factors of late death