Peri-Operative Mortality and Survival After Repair of Abdominal Aortic Aneurysm in Advanced Age Patients: A National Study from the Norwegian Registry for Vascular Surgery Focused on Nonagenarians

Kristin K Vikan; Arne Seternes; Linn Hege Nilsen; Erik Mulder Pettersen; Martin Altreuther

doi:10.1016/j.ejvs.2023.09.038

Peri-Operative Mortality and Survival After Repair of Abdominal Aortic Aneurysm in Advanced Age Patients: A National Study from the Norwegian Registry for Vascular Surgery Focused on Nonagenarians

Eur J Vasc Endovasc Surg. 2024 Mar;67(3):427-433. doi: 10.1016/j.ejvs.2023.09.038. Epub 2023 Sep 29.

Authors

Kristin K Vikan¹, Arne Seternes², Linn Hege Nilsen³, Erik Mulder Pettersen⁴, Martin Altreuther⁵

Affiliations

¹ The Norwegian Registry for Vascular Surgery (NORKAR), Department of Medical Quality Registries, Trondheim University Hospital, St. Olavs Hospital, Trondheim, Norway. Electronic address: Kristin.krangsas.vikan@stolav.no.
² Section of Vascular Surgery, Department of Surgery, Trondheim University Hospital, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
³ The Norwegian Registry for Vascular Surgery (NORKAR), Department of Medical Quality Registries, Trondheim University Hospital, St. Olavs Hospital, Trondheim, Norway.
⁴ The Norwegian Registry for Vascular Surgery (NORKAR), Department of Medical Quality Registries, Trondheim University Hospital, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway.
⁵ The Norwegian Registry for Vascular Surgery (NORKAR), Department of Medical Quality Registries, Trondheim University Hospital, St. Olavs Hospital, Trondheim, Norway; Section of Vascular Surgery, Department of Surgery, Trondheim University Hospital, St. Olavs Hospital, Trondheim, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.

PMID: 37778499
DOI: 10.1016/j.ejvs.2023.09.038

Abstract

Objective: Treatment of abdominal aortic aneurysm (AAA) in nonagenarians has become more frequent. This national observational cohort study aimed to investigate peri-operative mortality and survival after AAA surgery in nonagenarians in Norway.

Methods: All AAA repairs registered in the Norwegian Registry for Vascular Surgery from 2015 to 2021 were identified and stratified into nonagenarians > 90 years old (n = 77), octogenarians 80 - 89 years old (n = 1 362), and patients < 80 years old (n = 4 590). The patient characteristics and comorbidities were recorded, and the 30 and 90 day mortality rates were calculated. Kaplan-Meier analysis was performed to obtain the estimated median survival and survival curves.

Results: In the nonagenarians, the 30 day mortality rates were 2.5% in asymptomatic patients, 33.3% in symptomatic patients, and 59.1% in the patients with a ruptured AAA (rAAA). The estimated median survival (years) were 3.3 (95% confidence interval [CI] 1.95 - 4.59) for asymptomatic AAA, 2.9 (interquartile range [IQR] 2.82, 5.80) for symptomatic AAA, and 0.1 for rAAA (IQR 0.01, 3.04). For nonagenarians surviving the first 90 days, the estimated median survival (years) were 4.2 (95% CI 2.56 - 5.88) for asymptomatic AAA, 3.4 (IQR 2.86, 5.80) for symptomatic AAA, and 3.8 (IQR 1.49, 4.85) for rAAA. The 90 day mortality rates were 100.0%, 80.0%, and 62.5% for asymptomatic, symptomatic, and rAAA, respectively, after open surgical repair (OSR), and 5.1%, 10.0%, and 50.0%, respectively, after endovascular aortic repair (EVAR).

Conclusion: Peri-operative mortality and survival results after AAA surgery in nonagenarians support treatment of selected asymptomatic patients. The 90 day survivors had an expected survival of more than three years, enabling balanced decision making regarding surgical vs. conservative treatment options in this challenging cohort. EVAR is the treatment method of choice for AAA in nonagenarians because most of them would probably live longer untreated than if treated by OSR.

Keywords: Abdominal aortic aneurysm; Endovascular aneurysm repair; Nonagenarian; Open surgical repair; Outcome analysis; Vascular disease.

Publication types

Observational Study

MeSH terms

Aged, 80 and over
Aortic Aneurysm, Abdominal* / surgery
Aortic Rupture* / surgery
Blood Vessel Prosthesis Implantation* / methods
Endovascular Procedures* / methods
Humans
Nonagenarians
Registries
Retrospective Studies
Risk Factors
Treatment Outcome