Abdominal Aortic Aneurysm Repair in Nonagenarians.

Annals of vascular surgery

PubMedID: 25461753

Hughes K, Abdulrahman H, Prendergast T, Rose DA, Ongu'ti S, Tran D, Cornwell EE, Obisesan T, Amankwah KS. Abdominal Aortic Aneurysm Repair in Nonagenarians. Ann Vasc Surg. 2014;.
BACKGROUND
The feasibility of abdominal aortic aneurysm (AAA) repair in nonagenarians on a national level is largely unknown. We undertook this study to determine the outcomes of open and endovascular AAA repair in this population on a national level.

METHODS
A retrospective review of the Nationwide Inpatient Sample Database was conducted to determine all patients 90 years and older who underwent either an open or endovascular repair of a non-ruptured abdominal aortic aneurysm from 1997 to 2008. Preoperative comorbidities and postoperative complications in the inpatient setting were recorded. The primary endpoint was mortality. Secondary endpoints were postoperative neurologic, cardiac and respiratory complications. This group was then compared to all adult patients less than 90 years old (age 18 - 89) who had undergone repair of a non-ruptured abdominal aortic aneurysm during this same time period.

RESULTS
Four hundred and twenty-three patients 90 years and older underwent repair of a non-ruptured abdominal aortic aneurysm (compared to 52,370 < 90). Of these, 132 patients underwent open repair (31%) and 291 (69%) underwent endovascular repair. Inpatient mortality was 18.3% for the = 90 open, 4.6% for the < 90 open, 3.1% for the = 90 endovascular and 1.2% for < 90 endovascular group.

CONCLUSION
Whereas open repair of AAA's in nonagenarians is associated with significantly high perioperative mortality, endovascular repair is feasible with acceptable perioperative mortality. This mortality, while significantly higher than that obtained for endovascular repair in patients < 90, is nonetheless not significantly different for the mortality noted for patients < 90 undergoing open AAA repair.