Elective abdominal aortic aneurysm repair in the very elderly: a systematic review

Abdominal aortic aneurysm (AAA) is an age related disease, so the aging of the population has meant to more elderly people undergoing AAA repair. The authors conducted a systematic review of the literature to analyze the perioperative mortality and complication rates and long-term survival of elderly people after AAA repair. The literature was searched using the Embase, Cochrane library and Medline databases as at May 2008. All studies reporting on the perioperative and long-term outcomes of patients aged 80 years or more undergoing elective open (OAR) or endovascular AAA repair (EVAR) were considered. The risk of perioperative mortality and morbidity were calculated using the odds ratio (OR), with 95% confidence intervals (CIs), and the chi(2) test. Thirty-five studies on OAR, five on EVAR and four on both were considered. In the OAR group, the mortality rate (38 studies, 1793 patients) was 5.6% (95% CI, 4.5 to 6.7) and the morbidity rate (18 studies, 725 patients) was 26.9% (95% CI, 23.7 to 30.1). Twenty studies reported a median 5-year survival rate of 60% (range, 14% to 86%). In the EVAR group, the mortality rate (9 studies, 1159 patients) was 4.5% (95% CI, 3.3 to 5.7) and the morbidity rate (8 studies, 1078 patients) was 16.5% (95% CI, 14.3 to 18.7). The follow-up data covered less than 5 years in five studies. Although the perioperative death rate was higher after OAR than after EVAR, the difference was not statistically significant (P=0.170; 95% CI, 0.90 to 1.78). The major systemic morbidity rate was significantly higher after OAR (P<0.001; 95% CI, 1.47 to 2.34). Although the perioperative mortality rate was comparable between the two surgical procedures, the marked selection bias cannot be ignored and may well mean that the mortality rates are actually higher for both procedures. Although the mid- and long-term survival rates after OAR and EVAR could seem acceptable, more information is needed on the long-term outcome after EVAR in larger samples in order to assess the durability of this less invasive procedure.