International Collaborative Study Comparing Outcomes of Fenestrated Endovascular Aortic Repair in OCtogenarian vs Non-Octogenarian Patients: The FEVOC study

Carlota F Prendes; Paolo Spath; Manar Khashram; Nuno Dias; Federico Furlan; Ryan Gouveia E Melo; Enrico Gallitto; Björn Sonesson; Luis Mendes Pedro; Sinead Gormley; Mauro Gargiulo; Anders Wanhainen; Nikolaos Tsilimparis; Kevin Mani

doi:10.1097/SLA.0000000000006300

International Collaborative Study Comparing Outcomes of Fenestrated Endovascular Aortic Repair in OCtogenarian vs Non-Octogenarian Patients: The FEVOC study

Ann Surg. 2024 Apr 22. doi: 10.1097/SLA.0000000000006300. Online ahead of print.

Authors

Carlota F Prendes^{1

2}, Paolo Spath^{1

3}, Manar Khashram⁴, Nuno Dias⁵, Federico Furlan^{6

7}, Ryan Gouveia E Melo⁸, Enrico Gallitto^{3

9}, Björn Sonesson⁵, Luis Mendes Pedro⁸, Sinead Gormley⁴, Mauro Gargiulo^{3

9}, Anders Wanhainen², Nikolaos Tsilimparis¹, Kevin Mani²

Affiliations

¹ Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany.
² Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
³ Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy.
⁴ Department of Vascular & Endovascular Surgery, Waikato Hospital, Waikato, New Zealand.
⁵ Vascular Center, Skåne University Hospital, Malmö, Sweden.
⁶ Unit of Vascular and Endovascular Surgery, General Surgery Department, ASUFC, Hospital of Udine, Udine, Italy.
⁷ Department of Cardiac, Thoracic and Vascular Sciences, Vascular and Endovascular Surgery Clinic, Padova University, School of Medicine, Padova, Italy.
⁸ Vascular Surgery Department, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte (CHULN), Lisbon, Portugal.
⁹ Vascular Surgery Unit, IRCCS University Hospital Policlinico S.Orsola, Bologna, Italy.

PMID: 38647145
DOI: 10.1097/SLA.0000000000006300

Abstract

Objective: With an increasing life expectancy, more octogenarian patients are referred with complex aortic aneurysms (cAAA). The aim of this study was to evaluate short and mid-term outcomes following fenestrated aortic repair (FEVAR) in octogenarians.

Summary background data: Few studies looking at octogenarian-specific outcomes with diverging results.

Methods: Retrospective, multicentre cohort study including consecutive patients undergoing elective FEVAR for cAAAs or type IV thoracoabdominal aortic aneurysms between 2007-2022 in eight high-volume centres. Octogenarians vs. non-octogenarians were compared. The primary outcome was 30-day mortality. Secondary outcomes included 1, 2 and 5-year survival and reintervention rates.

Results: A total of 729 patients (median age of 74.8 years [IQR 69.2 - 79.14]) were included, 169 (23%) of which were octogenarians, with 316 (43.3%) patients undergoing juxta/pararenal aneurysm repair. Although octogenarians presented less complex but larger (61 mm vs. 58 mm) aneurysms, the number of fenestrations was similar across groups. No differences in in-hospital mortality (4.1 vs. 3.0%), MAE (16.6% vs 12.2%) or reintervention rates (11.2 vs. 10%) were found. Multivariable logistic regression of in-hospital mortality identified BMI (OR 0.66, 95% CI 0.51-0.95, P=0.003), chronic heart failure (OR 7.70, 95% CI 1.36-36.15, P=0.003) and GFR<45 ml/min/1.73 m2 (OR 5.25, 95% CI 1.20-22.86, P=0.027) as independent predictors. Median follow-up was 41 months. The 1, 2 and 5-year survival rates were 91.3%, 81.8% and 49.5% in octogenarians vs 90.6%, 86.5% and 68.8% in non-octogenarian patients (Log-rank: =0.001). Freedom from aortic-related death and freedom from reintervention at five-years were similar across groups (log-rank=0.94 and .76, respectively). Age>80 was not an independent predictor of 30-day or long-term mortality on multivariable and Cox regression analysis.

Conclusions: Elective FEVAR in octogenarians appears to be safe, with similar outcomes as in younger patients. Future studies looking at improved patient selection methods to ensure long-term survival benefits in both octogenarians and younger patients are warranted.