Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994–2014. (May 2017)

• Record Type: Journal Article
• Authors: Sonesson, B.; Björses, K.; Dias, N.; Rylance, R.; Mani, K.; Wanhainen, A.; Resch, T.
• Is Part Of: European journal of vascular and endovascular surgery. Volume 53:Number 5(2017)
• Page Start: 656
• Page End: 662
• Publication Date: 2017-05
• Subjects: Ruptured abdominal aortic aneurysm -- Octo- and nonagenarians -- Outcome -- Endovascular aneurysm repair -- Open repair; Blood-vessels -- Endoscopic surgery -- Periodicals; Blood-vessels -- Surgery -- Periodicals; Vascular Surgical Procedures -- Periodicals; Vascular Surgical Procedures -- methods -- Periodicals; Vaisseaux sanguins -- Chirurgie -- Périodiques; Vaisseaux sanguins -- Chirurgie endoscopique -- Périodiques; Blood-vessels -- Endoscopic surgery; Blood-vessels -- Surgery; Endoscopy; Electronic journals; Periodicals; Electronic journals; 617.413005
• DOI: 10.1016/j.ejvs.2017.02.010
• Languages: English
• ISSNs: 1078-5884

Abstract

Abstract : Objective: To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994–2014. Material and methods: 2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared using log-rank tests. The multivariate Cox model was used for adjusting for confounding factors between open repair (OR) and endovascular aneurysm repair (EVAR). Results: Crude survival after rAAA repair was 30 days (55%), 90 days (50%), 1 year (45%), 5 years (26%), and 10 years (9%). Long-term survival was 1 year (90%), 5 years (53%), and 10 years (18%). When individuals with rAAA were categorized into males and females, crude and long-term survival showed no significant differences ( p = .204 and p = .134). When rAAA patients were categorized into age groups (80–84 years, 85–89 years, 90+) crude survival diminished with increasing age, but long-term survival was not ( p = .009 and p = .368). Compared with the general population, rAAA patients showed only a minor decrease in relative survival. Crude survival after rAAA was better for EVAR compared with OR ( p = .007), hazard ratio 1.3 (95% CI 1.1–1.6, p < .012). Conclusions: There is a high (50%) peri-operative mortality after surgery for rAAA in octo- and nonagenarians, with no significant differences between the sexes and worse survival with increasing age. However, if a patient has survived the initial 90 days, long-term survival in this very old cohort is surprisingly good at more than 50% after 5 years, only slightly less than the general population.