Endovascular Aortic Repair in Nonagenarian Patients

J Am Coll Cardiol . 2021 Apr 20;77(15):1891-1899. doi: 10.1016/j.jacc.2021.02.042.

Fecha de la publicación: 20/04/2021

Autor: Carlota F Prendes (1), Anand Dayama (2), Jean M Panneton (3), Jan Stana (4), Barbara Rantner (4), Francisco Álvarez Marcos (3), Kevin Mani (5), Anders Wanhainen (5), Nikolaos Tsilimparis (4)

Palabras clave: aortic aneurysms, elderly population, endovascular aortic repair, nonagenarians, NSQIP, ruptures



1Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany. Electronic address: carlota.f.prendes@gmail.com.

2Division of Vascular Surgery, Eastern Virginia Medical School, Norfolk, Virginia, USA.

3Hospital Universitario Central de Asturias, Oviedo, Spain.

4Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany.

5Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.


Background: The increasing proportion of elderly patients being treated for abdominal aortic aneurysm (AAA) in the endovascular era is controversial.

Objectives: This study compared 30-day outcomes of endovascular aortic repair (EVAR) in nonagenarians (NAs) with non-nonagenarians (NNAs).

Methods: This retrospective analysis of the American College of Surgeons National Surgical Quality Improvement Program database included EVAR procedures performed from 2011 to 2017. Multivariate logistic regression in the unadjusted cohort, followed by propensity-score matching (PSM), was performed. Primary outcomes were 30-day mortality and 30-day major adverse events.

Results: A total of 12,267 patients were included (365 NAs). Ruptured aneurysms accounted for 6.7% (n = 819): 15.7% (n = 57) in NAs versus 6.5% (n = 762) in NNAs (p < 0.001). Mean aneurysm diameter was 6.5 ± 1.8 cm in NAs versus 5.8 ± 1.7 cm in NNAs (p < 0.001). The unadjusted 30-day mortality was 9.9% in NA versus 2.2% in NNAs (p < 0.001). Multivariate analysis revealed age ≥90 years (odds ratio [OR]: 3.36), male sex (OR: 1.78), functional status (OR: 4.22), pre-operative ventilator dependency (OR: 3.80), bleeding disorders (OR: 1.52), dialysis (OR: 2.56), and ruptured aneurysms (OR: 17.21) as independent predictors of mortality. After PSM, no differences in 30-day mortality (intact AAA [iAAA]: 5.3% NA vs. 3% NNA [p = 0.15]; ruptured AAA [rAAA]: 38% NA vs. 28.6% NNA [p = 0.32]) or 30-day major adverse events (iAAA: 7% NA vs. 4.6% NNA [p = 0.22]; rAAA: 28% NA vs. 36.7% NNA [p = 0.35]) were observed.

Conclusions: Age was identified as an independent predictor of 30-day mortality after EVAR on multivariate analysis. However, no differences were found after PSM, suggesting that being ≥90 years of age but with similar comorbidities to younger patients is not associated with a higher short-term mortality after EVAR. Age ≥90 years alone should not exclude patients from EVAR, and tailored indications and carefully balanced risk assessment are advised.