Elective abdominal aortic aneurysm repair in the very elderly: a systematic review.

ABSTRACT Background Abdominal aortic aneurysm (AAA) is an age related disease, so the people aging has led to an increased number of elderly undergoing AAA repair. To analyze the perioperative mortality and complications rates and long-term survival of elderly people after AAA repair, we conducted a systematic review of the literature. Methods The literature was searched using the Medline, Embase and Cochrane library databases up to May 2008. All studies reporting on perioperative and long-term outcomes of patients 80 years old or more undergoing elective open (OAR) or endovascular AAA repair (EVAR) were considered. The risk of perioperative mortality and morbidity were calculated using the odds ratio (OR), with 95% confidence intervals (CIs), and the χ2 test. Results Thirty-five studies on OAR, five on EVAR and four on both OAR and EVAR were included. In the OAR group, the mortality rate (38 studies/1793 patients) was 5.6% (95% CI, 4.5 to 6.7) and the morbidity rate (18 studies/725 patients) 26.9% (95% CI, 23.7 to 30.1). Twenty studies reported a median 5-year survival rate of 60% (range, 14% to 86%). In the EVAR group, the mortality rate (9 studies/1159 patients) was 4.5% (95% CI, 3.3 to 5.7) and the morbidity rate (8 studies/1078 patients) 16.9% (95% CI, 23.7 to 30.1). Follow-up data lasted < 5 years in 5 studies. Although the perioperative death rate was higher after OAR than after EVAR, the difference was not statistically significant (p = .170; 95% CI, 0.90 to 1.78). The rate of major systemic morbidity was significantly higher after OAR (p < .01; 95% CI, 1.43 to 2.26). Conclusions Although the perioperative mortality rate was comparable between the two surgical procedures, the high levels of selection bias cannot be ignored and could actually indicate higher mortality rates for both procedures. Although mid- and long-term survival rates after OAR and EVAR were acceptable, more information on long-term outcome after EVAR with a greater sample size is needed to evaluate the durability of the less invasive procedure.