Endovascular Aortic Aneurysm Repair in the Octogenarian: Is It Worthwhile?

Michael E. Minor, Sharif Ellozy, Alfio Carroccio, Juliana Oak, Kristina Chae, Gautam Agarwal, Ryan Surmay, Victoria Teodorescu, Nicholas J. Morrissey, Tikva Jacobs, Robert Lookstein, Larry H. Hollier, Michael L. Marin

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Hypothesis: During the past decade, endovascular stent graft repair (EVSG) of abdominal aortic aneurysms has emerged as a less invasive and less morbid alternative to open surgical repair. We hypothesize that EVSG may become the treatment method of choice among patients older than 80 years. Design: Retrospective case series. Setting: Major academic medical center with extensive experience in endovascular and open aortic aneurysm surgery. Patients and Methods: During a 5-year period, EVSG was performed in 595 patients at our institution. One hundred fifty (25.2%) of these patients were older than 80 years. Our prospectively acquired database was reviewed with respect to the demographic, intraoperative, and outcome data of this elderly population. Main Outcome Measures: Technical and clinical success, aneurysm-related events (aneurysm-related death, type I or type III endoleaks, aneurysm expansion, or aneurysm rupture), and secondary interventions. Results: There were 119 men (79.3%) and 31 women (20.7%) (mean age, 84.6 years). Mean aneurysm diameter was 6.7 cm. Comorbidities including chronic obstructive pulmonary disease, coronary artery disease, chronic renal insufficiency, peripheral vascular disease, hypertension, and hypercholesterolemia were common in these patients, with an average of 2.9 comorbid conditions per patient. Mean follow-up was 16.9 months (range, 1.0-61.4 months). One hundred forty-six patients (97.3%) received only regional anesthesia, and the average intraoperative blood loss was 369 mL. Average hospital and intensive care unit stays were 2.5 days and 0.1 day, respectively. The procedure was performed emergently in 3 patients, and each recovered uneventfully. There were 5 aborted procedures (3.3%) for technical reasons and 4 conversions to open aortic repair (2.6%). In addition to these aborted procedures, there were 2 additional technical failures resulting in a technical success rate of 95.3%. Endoleaks were common and included 9 type I (6.90%), 35 type II (24.10%), and I type III (0.69%). The majority either resolved spontaneously (type IIs) or with minimally invasive secondary intervention, which was performed in 13 patients. Perioperative local/vascular and systemic complications occurred in 16 (10.7%) and 8 (5.3%) patients, respectively. There were 5 perioperative deaths (3.3%)(<30 days postoperatively). Forty late deaths (26.7%)(>30 days postoperatively) occurred, which were unrelated to the EVSG procedure. Conclusions: Endovascular repair of abdominal aortic aneurysms can be performed safely and successfully in the majority of octogenarians with relatively low complication rates. Improved EVSG devices and operator experience may make this procedure the treatment method of choice for patients in this age group who meet specific anatomical criteria.

Original languageEnglish (US)
Pages (from-to)308-314
Number of pages7
JournalArchives of Surgery
Volume139
Issue number3
DOIs
StatePublished - Mar 1 2004
Externally publishedYes

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Aortic Aneurysm
Stents
Aneurysm
Transplants
Endoleak
Abdominal Aortic Aneurysm
Conduction Anesthesia
Peripheral Vascular Diseases
Hypercholesterolemia
Chronic Renal Insufficiency
Chronic Obstructive Pulmonary Disease
Blood Vessels
Intensive Care Units
Comorbidity
Coronary Artery Disease
Rupture
Age Groups
Demography
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery

Cite this

Minor, M. E., Ellozy, S., Carroccio, A., Oak, J., Chae, K., Agarwal, G., ... Marin, M. L. (2004). Endovascular Aortic Aneurysm Repair in the Octogenarian: Is It Worthwhile? Archives of Surgery, 139(3), 308-314. https://doi.org/10.1001/archsurg.139.3.308

Endovascular Aortic Aneurysm Repair in the Octogenarian : Is It Worthwhile? / Minor, Michael E.; Ellozy, Sharif; Carroccio, Alfio; Oak, Juliana; Chae, Kristina; Agarwal, Gautam; Surmay, Ryan; Teodorescu, Victoria; Morrissey, Nicholas J.; Jacobs, Tikva; Lookstein, Robert; Hollier, Larry H.; Marin, Michael L.

In: Archives of Surgery, Vol. 139, No. 3, 01.03.2004, p. 308-314.

Research output: Contribution to journalArticle

Minor, ME, Ellozy, S, Carroccio, A, Oak, J, Chae, K, Agarwal, G, Surmay, R, Teodorescu, V, Morrissey, NJ, Jacobs, T, Lookstein, R, Hollier, LH & Marin, ML 2004, 'Endovascular Aortic Aneurysm Repair in the Octogenarian: Is It Worthwhile?', Archives of Surgery, vol. 139, no. 3, pp. 308-314. https://doi.org/10.1001/archsurg.139.3.308
Minor, Michael E. ; Ellozy, Sharif ; Carroccio, Alfio ; Oak, Juliana ; Chae, Kristina ; Agarwal, Gautam ; Surmay, Ryan ; Teodorescu, Victoria ; Morrissey, Nicholas J. ; Jacobs, Tikva ; Lookstein, Robert ; Hollier, Larry H. ; Marin, Michael L. / Endovascular Aortic Aneurysm Repair in the Octogenarian : Is It Worthwhile?. In: Archives of Surgery. 2004 ; Vol. 139, No. 3. pp. 308-314.
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abstract = "Hypothesis: During the past decade, endovascular stent graft repair (EVSG) of abdominal aortic aneurysms has emerged as a less invasive and less morbid alternative to open surgical repair. We hypothesize that EVSG may become the treatment method of choice among patients older than 80 years. Design: Retrospective case series. Setting: Major academic medical center with extensive experience in endovascular and open aortic aneurysm surgery. Patients and Methods: During a 5-year period, EVSG was performed in 595 patients at our institution. One hundred fifty (25.2{\%}) of these patients were older than 80 years. Our prospectively acquired database was reviewed with respect to the demographic, intraoperative, and outcome data of this elderly population. Main Outcome Measures: Technical and clinical success, aneurysm-related events (aneurysm-related death, type I or type III endoleaks, aneurysm expansion, or aneurysm rupture), and secondary interventions. Results: There were 119 men (79.3{\%}) and 31 women (20.7{\%}) (mean age, 84.6 years). Mean aneurysm diameter was 6.7 cm. Comorbidities including chronic obstructive pulmonary disease, coronary artery disease, chronic renal insufficiency, peripheral vascular disease, hypertension, and hypercholesterolemia were common in these patients, with an average of 2.9 comorbid conditions per patient. Mean follow-up was 16.9 months (range, 1.0-61.4 months). One hundred forty-six patients (97.3{\%}) received only regional anesthesia, and the average intraoperative blood loss was 369 mL. Average hospital and intensive care unit stays were 2.5 days and 0.1 day, respectively. The procedure was performed emergently in 3 patients, and each recovered uneventfully. There were 5 aborted procedures (3.3{\%}) for technical reasons and 4 conversions to open aortic repair (2.6{\%}). In addition to these aborted procedures, there were 2 additional technical failures resulting in a technical success rate of 95.3{\%}. Endoleaks were common and included 9 type I (6.90{\%}), 35 type II (24.10{\%}), and I type III (0.69{\%}). The majority either resolved spontaneously (type IIs) or with minimally invasive secondary intervention, which was performed in 13 patients. Perioperative local/vascular and systemic complications occurred in 16 (10.7{\%}) and 8 (5.3{\%}) patients, respectively. There were 5 perioperative deaths (3.3{\%})(<30 days postoperatively). Forty late deaths (26.7{\%})(>30 days postoperatively) occurred, which were unrelated to the EVSG procedure. Conclusions: Endovascular repair of abdominal aortic aneurysms can be performed safely and successfully in the majority of octogenarians with relatively low complication rates. Improved EVSG devices and operator experience may make this procedure the treatment method of choice for patients in this age group who meet specific anatomical criteria.",
author = "Minor, {Michael E.} and Sharif Ellozy and Alfio Carroccio and Juliana Oak and Kristina Chae and Gautam Agarwal and Ryan Surmay and Victoria Teodorescu and Morrissey, {Nicholas J.} and Tikva Jacobs and Robert Lookstein and Hollier, {Larry H.} and Marin, {Michael L.}",
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T1 - Endovascular Aortic Aneurysm Repair in the Octogenarian

T2 - Is It Worthwhile?

AU - Minor, Michael E.

AU - Ellozy, Sharif

AU - Carroccio, Alfio

AU - Oak, Juliana

AU - Chae, Kristina

AU - Agarwal, Gautam

AU - Surmay, Ryan

AU - Teodorescu, Victoria

AU - Morrissey, Nicholas J.

AU - Jacobs, Tikva

AU - Lookstein, Robert

AU - Hollier, Larry H.

AU - Marin, Michael L.

PY - 2004/3/1

Y1 - 2004/3/1

N2 - Hypothesis: During the past decade, endovascular stent graft repair (EVSG) of abdominal aortic aneurysms has emerged as a less invasive and less morbid alternative to open surgical repair. We hypothesize that EVSG may become the treatment method of choice among patients older than 80 years. Design: Retrospective case series. Setting: Major academic medical center with extensive experience in endovascular and open aortic aneurysm surgery. Patients and Methods: During a 5-year period, EVSG was performed in 595 patients at our institution. One hundred fifty (25.2%) of these patients were older than 80 years. Our prospectively acquired database was reviewed with respect to the demographic, intraoperative, and outcome data of this elderly population. Main Outcome Measures: Technical and clinical success, aneurysm-related events (aneurysm-related death, type I or type III endoleaks, aneurysm expansion, or aneurysm rupture), and secondary interventions. Results: There were 119 men (79.3%) and 31 women (20.7%) (mean age, 84.6 years). Mean aneurysm diameter was 6.7 cm. Comorbidities including chronic obstructive pulmonary disease, coronary artery disease, chronic renal insufficiency, peripheral vascular disease, hypertension, and hypercholesterolemia were common in these patients, with an average of 2.9 comorbid conditions per patient. Mean follow-up was 16.9 months (range, 1.0-61.4 months). One hundred forty-six patients (97.3%) received only regional anesthesia, and the average intraoperative blood loss was 369 mL. Average hospital and intensive care unit stays were 2.5 days and 0.1 day, respectively. The procedure was performed emergently in 3 patients, and each recovered uneventfully. There were 5 aborted procedures (3.3%) for technical reasons and 4 conversions to open aortic repair (2.6%). In addition to these aborted procedures, there were 2 additional technical failures resulting in a technical success rate of 95.3%. Endoleaks were common and included 9 type I (6.90%), 35 type II (24.10%), and I type III (0.69%). The majority either resolved spontaneously (type IIs) or with minimally invasive secondary intervention, which was performed in 13 patients. Perioperative local/vascular and systemic complications occurred in 16 (10.7%) and 8 (5.3%) patients, respectively. There were 5 perioperative deaths (3.3%)(<30 days postoperatively). Forty late deaths (26.7%)(>30 days postoperatively) occurred, which were unrelated to the EVSG procedure. Conclusions: Endovascular repair of abdominal aortic aneurysms can be performed safely and successfully in the majority of octogenarians with relatively low complication rates. Improved EVSG devices and operator experience may make this procedure the treatment method of choice for patients in this age group who meet specific anatomical criteria.

AB - Hypothesis: During the past decade, endovascular stent graft repair (EVSG) of abdominal aortic aneurysms has emerged as a less invasive and less morbid alternative to open surgical repair. We hypothesize that EVSG may become the treatment method of choice among patients older than 80 years. Design: Retrospective case series. Setting: Major academic medical center with extensive experience in endovascular and open aortic aneurysm surgery. Patients and Methods: During a 5-year period, EVSG was performed in 595 patients at our institution. One hundred fifty (25.2%) of these patients were older than 80 years. Our prospectively acquired database was reviewed with respect to the demographic, intraoperative, and outcome data of this elderly population. Main Outcome Measures: Technical and clinical success, aneurysm-related events (aneurysm-related death, type I or type III endoleaks, aneurysm expansion, or aneurysm rupture), and secondary interventions. Results: There were 119 men (79.3%) and 31 women (20.7%) (mean age, 84.6 years). Mean aneurysm diameter was 6.7 cm. Comorbidities including chronic obstructive pulmonary disease, coronary artery disease, chronic renal insufficiency, peripheral vascular disease, hypertension, and hypercholesterolemia were common in these patients, with an average of 2.9 comorbid conditions per patient. Mean follow-up was 16.9 months (range, 1.0-61.4 months). One hundred forty-six patients (97.3%) received only regional anesthesia, and the average intraoperative blood loss was 369 mL. Average hospital and intensive care unit stays were 2.5 days and 0.1 day, respectively. The procedure was performed emergently in 3 patients, and each recovered uneventfully. There were 5 aborted procedures (3.3%) for technical reasons and 4 conversions to open aortic repair (2.6%). In addition to these aborted procedures, there were 2 additional technical failures resulting in a technical success rate of 95.3%. Endoleaks were common and included 9 type I (6.90%), 35 type II (24.10%), and I type III (0.69%). The majority either resolved spontaneously (type IIs) or with minimally invasive secondary intervention, which was performed in 13 patients. Perioperative local/vascular and systemic complications occurred in 16 (10.7%) and 8 (5.3%) patients, respectively. There were 5 perioperative deaths (3.3%)(<30 days postoperatively). Forty late deaths (26.7%)(>30 days postoperatively) occurred, which were unrelated to the EVSG procedure. Conclusions: Endovascular repair of abdominal aortic aneurysms can be performed safely and successfully in the majority of octogenarians with relatively low complication rates. Improved EVSG devices and operator experience may make this procedure the treatment method of choice for patients in this age group who meet specific anatomical criteria.

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