Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Octogenarians: Meta-analysis and Systematic Review

Abstract

Objectives: This meta-analysis and systematic review aimed to highlight the results of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA) to assess safety and effectiveness in patients older than 80 years of age compared with younger patients.

Methods: PRISMA guidelines were used; quality was appraised, and data were extracted and analysed following the Cochrane collaboration. The MEDLINE and Embase databases were searched on December 31, 2016. All studies related to clinical outcomes following EVAR for AAA treatment in octogenarians compared with those in younger patients were included for a meta-analysis and systematic review of short- and midterm outcomes. Data were analysed using a fixed or random effects model by pooling and calculating odds ratios (ORs) or hazard ratios (HRs) and weighted mean differences, to investigate the safety and feasibility of endoluminal treatment in octogenarians.

Results: Published literature search identified nine observational studies, comprising 25,723 patients with AAA (5989 octogenarians and 19,734 younger patients). More males (OR 0.621, p=.002) and smokers (OR 0.457, p<.001) were observed in the younger group. Frequent concomitant diseases were associated with advanced age, thus, the procedural duration, blood loss estimation, and length of stay were considerably higher among octogenarians. Although elderly patients have a higher 30 day mortality (2.7% vs. 1.5%, p<.001), endoleak, pulmonary, and renal diseases, no significant difference was found in the technical success of the procedure. As expected, the HR for octogenarians was markedly higher than that of younger patients (HR 1.946, p<.001) for midterm all-cause mortality. However, the re-intervention rate to maximum follow-up period of 5 years was not significantly different (HR 1.148, p=.408) between the groups.

Conclusion: Compared with younger patients, EVAR in octogenarians is associated with a significantly higher but still acceptable peri-operative and midterm mortality rate. Because of similar midterm re-intervention rates, these findings suggest that EVAR remains an appropriate therapeutic approach in the elderly group if comprehensive pre-operative evaluation and post-operative surveillance are incorporated.

Keywords: Abdominal aortic aneurysm; Endovascular repair; Meta-analysis; Octogenarians.