Open abdominal aortic aneurysm repair in octogenarians before and after the adoption of endovascular grafting procedures.

Abstract Objective To evaluate elective open abdominal aortic aneurysm repair (OAR) in patients ≥ 80 years old before and after stent graft devices for endovascular aneurysm repair (EVAR) became commercially available, and the effect on perioperative (30-day) outcome of the anatomical constraints that led to EVAR being excluded for many of them. Methods A review was conducted on the records of 111 patients ≥ 80 years old who underwent elective OAR during a 14-year period at our institution. Patients were separated into two groups depending on whether OAR was performed before (65 patients, group 1) or after (46 patients, group 2) an EVAR program was adopted at our University Medical School in mid-2000. Perioperative death and morbidity, location of proximal aortic clamp, management of the left renal vein (LRV), associated iliac aneurysmal or occlusive diseases, the type of surgical reconstruction, operating time, intensive care unit stay and hospital length of stay were recorded and all the data were compared between the two groups. Results Retroperitoneal approach, suprarenal clamping, LRV 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 there were significantly more iliac aneurysms in group 2 (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. There was a significantly higher incidence of kidney failure in group 2 (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 This study shows that 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.