Octogenarians submitted to elective infrarenal abdominal aortic aneurysm repair: can they currently be considered "high-risk" for open repair?

Aim. The aim of this paper was to report our experience in octogenarian patients affected by infrarenal abdominal aortic aneurysm (AAA) and to compare the outcomes between patients electively treated by open repair (OR) or endovascular aneurysm repair (EVAR). Methods. Among 576 patients treated for elective infrarenal AAA repair between January 2002 and July 2009 we identified 82 >= 80 years in our prospectively collected departmental database. We compared results between the two groups of patients according to: perioperative (30-days) and late mortality related or nor to AAA, perioperative morbidity, length of in-hospital stay, other complications prolonging length of in-hospital stay (LHS). A P<0.05 was considered statistically significant. Results. Fifty-three patients underwent OR and twenty-nine EVAR. Mean follow-up time was 38.2 months (range 6-96). Technical success was achieved in all patients. One perioperative death was recorded in the EVAR group while 3 OR patients died within 30 days (P=0.55). Overall survival estimates at 60 months were 77% and 55% in OR and EVAR groups respectively. No late aneurysm-related deaths were recorded in OR group while 1 death occurred in the EVAR group (P=0.35). Analysis of late mortality rates unrelated to aneurysm showed a mild statistical significance in favour of OR (22.6% vs. 41.3%; P=0.042). Total late death rates revealed a significant difference between the two groups in fayour of OR (EVAR 44.8%, OR 22.6%, P=0.02). Analysis of total perioperative complications between groups proved no significant differences but subgroup analysis of systemic and local complications displayed worst results for OR and EVAR respectively (20.7% and 24.1%). Both types of complications caused a significant longer in-hospital stay in the two groups (P=NS). Conclusion. Elective EVAR and OR for infrarenal AAA seem safe and effective in patients older than 80 years at early and late results. Age alone should not prevent clinicians from treating those patients by OR.