Early Outcomes After Branched and Fenestrated Endovascular Aortic Repair in Octogenarians

Eur J Vasc Endovasc Surg. 2018 Dec;56(6):818-825. doi: 10.1016/j.ejvs.2018.08.009. Epub 2018 Sep 18.


Aim: To compare early outcome after complex endovascular aortic repair in octogenarians (age ≥ 80 years) versus non-octogenarians (age < 80 years) treated with fenestrated or branched stent grafts.

Methods: Single centre retrospective analysis from a prospectively collected database of all patients undergoing repair with fenestrated or branched stent grafts for para/suprarenal aortic aneurysm, type Ia endoleak after previous endovascular aortic repair, and thoraco-abdominal aortic aneurysm between January 2015 and December 2017. Early all cause mortality, major adverse events, and need for re-intervention were analysed for non-octogenarians (age < 80 years) and octogenarians (age ≥ 80 years) at the time of repair.

Results: 207 patients (58 [28%] females) with a median age of 73 years (IQR 68-78) underwent repair with fenestrated or branched stent grafts. There were 169 (81%) non-octogenarians with a median age of 72 years (IQR 65-76) and 38 (19%) octogenarians with a median age of 82 years (IQR 81-84). The number of patients with chronic kidney disease was significantly higher in the octogenarians (63 [37%] vs. 22 [58%], p = .03]. Nineteen patients (9%) died. The early mortality rate was higher in the octogenarians (12 [7%] vs. 7 [18%], p = .06]. Mortality rate was 4% (6/148) for elective and 22% (13/59) for urgently treated patients. Similar rates of post-operative sepsis, stroke, respiratory problems, need for dialysis, and spinal cord injury were found in both groups. Two patients in each group had early stent graft related re-interventions. The octogenarian group had increased post-operative creatinine values (1.0 [0.8-1.4] vs. 1.4 [1.0-1.9], p = .01). After multiple logistic regression, ASA class ≥4 and rupture were independent factors of early all cause mortality.

Conclusions: Complex endovascular repair in octogenarians has higher early all cause mortality compared with non-octogenarians. Rupture and higher ASA class of ≥4 are independent predictors for early mortality. Age ≥80 years was found to be an independent predictor for higher early all cause mortality.

Keywords: Branched and fenestrated stent graft; Complex endovascular aortic repair; Early outcome; Octogenarians.

Publication types

  • Observational Study

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anastomotic Leak / surgery*
  • Aortic Aneurysm, Abdominal / classification
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Aneurysm, Thoracic / classification
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Rupture / mortality
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / methods*
  • Female
  • Humans
  • Male
  • Postoperative Complications
  • Reoperation
  • Retrospective Studies
  • Stents*
  • Survival Analysis
  • Treatment Outcome