Open abdominal aortic aneurysm repair in octogenarians before and after the adoption of endovascular grafting procedures
Received 6 July 2007; accepted 31 August 2007. published online 30 November 2007.
Objective
This study evaluated (1) elective open abdominal aortic aneurysm repair (OAR) in patients aged ≥80 years before and after stent graft devices for endovascular aneurysm repair (EVAR) became commercially available and (2) the effect on perioperative (30-day) outcome of the anatomic constraints that led to EVAR being excluded for many of them.
Methods
A review was conducted on the records of 111 patients aged ≥80 years who underwent elective OAR during a 14-year period at the University of Padua School of Medicine. Patients were separated into two groups: group 1 (n = 65) had OAR before and group 2 (n = 46) after an EVAR program was adopted at the medical school in mid-2000. Perioperative death and morbidity, location of proximal aortic clamp, management of the left renal vein, associated iliac aneurysmal or occlusive diseases, the type of surgical reconstruction, operating time, and lengths of stay in the intensive care unit and the hospital were recorded. All the data were compared between the two groups.
Results
Retroperitoneal approach, suprarenal clamping, left renal vein division, and longer operating room time were statistically more common in group 2 (36.9% vs 12.3%, P = .002; 15.2% vs 3.1%, P = .032; 23.9% vs 7.7%, P = .026; and 117 ± 8 min vs 95 ±7 min, P < .001, respectively). Although group 2 had significantly more iliac aneurysms (52.1% vs 32.3%; P = .036), the number of bifurcated reconstructions was comparable. The overall perioperative mortality rate was 1.8% (2 of 111), and the figures for groups 1 and 2 were comparable (3.1% vs 0%; P = .510). No deaths were cardiac related. Group 2 had a significantly higher incidence of kidney failure (8.7% vs 0%; P = .027). Kaplan-Meier analysis showed an overall 3-, 5-, and 10-year survival rate of 80.6%, 67.2%, and 59.4%, respectively, with a 3- and 5-year survival rate comparable between groups 1 and 2 (77.8% and 66.7% vs 87.8% and 45.8%, respectively; log-rank test, P = .921).
Conclusions
Octogenarians can tolerate OAR with acceptable rates of perioperative mortality and morbidity. Although the complexity of OAR has increased significantly in the era of EVAR, the perioperative outcome has not changed.
aVascular Surgery Section of the Geriatric Surgery Clinic, University of Padua, School of Medicine, Padova, Italy
bDepartment of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, Padova, Italy.
Reprint requests: Enzo Ballotta, MD, Vascular Surgery Section of the Geriatric Surgery Clinic, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, 2 Piano Ospedale Giustinianeo, Via N. Giustiniani 2, 35128 Padova, Italy.
ABSTRACT