Journal of Geriatric Cardiology 2012/9:3 PP.285-291
Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date.
1 Cosford PA, Leng GC. Screening for abdominal aortic aneurysm. Cochrane Database Syst Rev 2007; CD002945.
2 Lovegrove RE, Javid M, Magee TR, et al. A meta-analysis of 21,178 patients undergoing open or endovascular repair of abdominal aortic aneurysm. Br J Surg 2008; 95: 677-684.
3 World Population Ageing: 1950-2050, 2005; http://www. un.org/esa/population/publications/worldageing19502050/(ac-cessed in June 2012).
4 Greenhalgh RM, Brown LC, Kwong GP, et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1), 30-day operative mortality results: randomised controlled trial. Lancet 2004; 364: 843-848.
5 Greenhalgh RM. Commentary: impact of EVAR and DREAM trials on clinical practice. J Endovasc Ther 2007; 14: 541-543.
6 De Bruin JL, Baas AF, Buth J, et al. Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 2010; 362; 1881-1889.
7 Prinssen M, Verhoeven EL, Buth J, et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 2004; 351: 1607-1618.
8 Upchurch GR Jr. Open versus endovascular abdominal aortic aneurysm repair: which offers the best long-term outcome? Nat Clin Pract Cardiovasc Med 2005; 2: 562-563.
9 Upchurch GR Jr., Eliason JL, Rectenwald JE, et al. Endovascular abdominal aortic aneurysm repair versus open repair: why and why not? Perspect Vasc Surg Endovasc Ther 2009; 21: 48-53.
10 Ren S, Fan X, Ye Z, et al. Long-term outcomes of endovascular repair versus open repair of abdominal aortic aneurysm. Ann Thorac Cardiovasc Surg 2012; 18: 222-227.
11 Brinkman WT, Terramani TT, Najibi S et al. Endovascular abdominal aortic aneurysm repair in the octogenarian. Ann Vasc Surg 2004; 18: 401-407.
12 Botsios S, Schmidt A, Klaeffling C, et al. Endovascular treatment of abdominal aortic aneurysms in octogenarians. Zentralbl Chir 2009; 134: 325-330.
13 Kurz M, Meier T, Pfammatter T, et al. Quality of life survey after endovascular abdominal aortic aneurysm repair in octogenarians. Int Angiol 2010; 29: 249-254.
14 Prenner SB, Turnbull IC, Malik R, et al. Outcome of elective endovascular abdominal aortic aneurysm repair in octogenarians and nonagenarians. J Vasc Surg; 2010; 51: 1354-1359.
15 Biebl M, Lau LL, Hakaim AG, et al. Midterm outcome of endovascular abdominal aortic aneurysm repair in octogenarians: a single institution's experience. J Vasc Surg 2004; 40: 435-442.
16 Fonseca R, Rockman C, Pitti A, et al. Intermediate-term EVAR outcomes in octogenarians. J Vasc Surg 2010; 52: 556-560; discussion 560-561.
17 Pol RA, Zeebregts CJ, van Sterkenburg SM, et al. Thirty-day outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians based on the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE). J Vasc Surg 2012; 56: 27-35.
18 Raval MV, Eskandari MK. Outcomes of elective abdominal aortic aneurysm repair among the elderly: endovascular versus open repair. Surgery 2012; 151: 245-260.
19 Schermerhorn ML, O'Malley AJ, Jhaveri A, et al. Endovascular vs. open repair of abdominal aortic aneurysms in the Medicare population. N Engl J Med 2008; 358: 464-474.
20 Schwarze ML, Shen Y, Hemmerich J, et al. Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001-2006. J Vasc Surg 2009; 50: 722-729.e2.
21 Biancari F, Catania A, D'Andrea V. Elective endovascular vs. open repair for abdominal aortic aneurysm in patients aged 80 years and older: systematic review and meta-analysis. Eur J Vasc Endovasc Surg 2011; 42: 571-576.
22 Sicard GA, Rubin BG, Sanchez LA, et al. Endoluminal graft repair for abdominal aortic aneurysms in high-risk patients and octogenarians: is it better than open repair? Ann Surg 2001; 234: 427-435; discussion 435-437.
23 Patel AP, Langan EM 3rd, Taylor SM, et al. An analysis of standard open and endovascular surgical repair of abdominal aortic aneurysms in octogenarians. Am Surg 2003; 69: 744-747.
24 Leon LR Jr., Labropoulos N, Laredo J, et al. To what extent has endovascular aneurysm repair influenced abdominal aortic aneurysm management in the state of Illinois? J Vasc Surg 2005 Apr; 41: 568-574.
25 Paolini D, Chahwan S, Wojnarowski D, et al. Elective endovascular and open repair of abdominal aortic aneurysms in octogenarians. J Vasc Surg 2008; 47: 924-927.
26 de Donato G, Setacci C, Chisci E, et al. Abdominal aortic aneurysm repair in octogenarians: myth or reality? J Cardiovasc Surg (Torino) 2007; 48: 697-703.
27 Cuypers PW, Gardien M, Buth J, et al. Randomized study comparing cardiac response in endovascular and open abdominal aortic aneurysm repair. Br J Surg 2001; 88: 1059-1065.
28 Prinssen M, Buskens E, Blankensteijn JD. The Dutch Randomised Endovascular Aneurysm Management (DREAM) trial. Background, design and methods. J Cardiovasc Surg (Torino) 2002; 43: 379-384.
29 Brown LC, Epstein D, Manca A, et al. The UK Endovascular Aneurysm Repair (EVAR) trials: design, methodology and progress. Eur J Vasc Endovasc Surg 2004; 27: 372-381.
30 Greenhalgh RM, Brown LC, Powell JT, et al. Endovascular repair of aortic aneurysm in patients physically ineligible for open repair. N Engl J Med 2010; 362: 1872-1880.
31 Brown LC, Greenhalgh RM, Thompson SG, et al. Does EVAR alter the rate of cardiovascular events in patients with abdominal aortic aneurysm considered unfit for open repair? Results from the randomised EVAR trial 2. Eur J Vasc Endovasc Surg 2010; 39: 396-402.
32 Becquemin JP, Pillet JC, Lescalie F, et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate- risk patients. J Vasc Surg 2011; 53: 1167-1173 e1.
33 Lederle FA, Freischlag JA, Kyriakides TC, et al. Outcomes following endovascular vs. open repair of abdominal aortic aneurysm: a randomized trial. JAMA 2009; 302: 1535-1542.
34 Greenhalgh RM, Brown LC, Powell JT, et al. Current interpretation of the UK EVAR Trials. Acta Chir Belg 2006; 106: 137-138.
35 Montan C, Lehti L, Holst J, et al. Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair. J Endovasc Ther 2011; 18: 789-796.
36 Saratzis N, Saratzis A, Melas N, et al. Non-activated autologous platelet-rich plasma for the prevention of inguinal wound-related complications after endovascular repair of abdominal aortic aneurysms. J Extra Corpor Technol 2008; 40: 52-56.
37 Malkawi AH, Hinchliffe RJ, Holt PJ, et al. Percutaneous access for endovascular aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg 2010; 39: 676-682.
38 Wald R, Waikar SS, Liangos O, et al. Acute renal failure after endovascular vs. open repair of abdominal aortic aneurysm. J Vasc Surg 2006; 43: 460-466; discussion 466.
39 Giles KA, Hamdan AD, Pomposelli FB, et al. Population-based outcomes following endovascular and open repair of ruptured abdominal aortic aneurysms. J Endovasc Ther 2009; 16: 554- 564.
40 Giles KA, Pomposelli FB, Hamdan AD, et al. Comparison of open and endovascular repair of ruptured abdominal aortic aneurysms from the ACS-NSQIP 2005-07. J Endovasc Ther 2009; 16: 365-372.
41 Abraham CZ, Chuter TA, Reilly LM, et al. Abdominal aortic aneurysm repair with the Zenith stent graft: short to midterm results. J Vasc Surg 2002; 36: 217-224; discussion 224-225.
42 Allie DE, Lirtzman MD, Wyatt CH, et al. Targeted renal therapy and contrast-induced nephropathy during endovascular abdominal aortic aneurysm repair: results of a feasibility pilot trial. J Endovasc Ther 2007; 14: 520-527.
43 Walsh SR, Boyle JR, Tang TY, et al. Remote ischemic preconditioning for renal and cardiac protection during endovascular aneurysm repair: a randomized controlled trial. J Endovasc Ther 2009; 16: 680-689.
44 Lee AD, Hall RG. An evaluation of the use of carbon dioxide angiography in endovascular aortic aneurysm repair. Vasc Endovascular Surg 2010; 44: 341-344.
45 Parra JR, Crabtree T, McLafferty RB, et al. Anesthesia technique and outcomes of endovascular aneurysm repair. Ann Vasc Surg 2005; 19: 123-129.
46 Moore NN, Lapsley M, Norden AG, et al. Does N-acetylcysteine prevent contrast-induced nephropathy during endovascular AAA repair? A randomized controlled pilot study. J Endovasc Ther 2006; 13: 660-666.
47 Bown MJ, Norwood MG, Sayers RD. The management of abdominal aortic aneurysms in patients with concurrent renal impairment. Eur J Vasc Endovasc Surg 2005; 30: 1-11.
48 Giles KA, Landon BE, Cotterill P, et al. Thirty-day mortality and late survival with reinterventions and readmissions after open and endovascular aortic aneurysm repair in Medicare beneficiaries. J Vasc Surg 2011; 53: 6-12, 13.e1.
49 Kieffer WK, Sonnenberg S, Windhaber RA, et al. Complications and reintervention following elective open abdominal aortic aneurysm repair: a 10-year retrospective analysis. Ann R Coll Surg Engl 2012; 94: 177-180.