Endovascular aneurysm repair in the elderly: First do no harm

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Health Economics

Background:

• Endovascular aneurysm repair (EVAR) is preferred for aortic aneurysms due to lower 30-day mortality versus open surgery.
• EVAR trials often excluded patients over 80, and elderly EVAR shows higher mortality rates.
• Cost-effectiveness analyses do not consistently favor EVAR over open repair, especially with complications like endoleak.

Purpose of the Study:

• To address the clinical need for risk stratification in elderly patients undergoing EVAR.
• To identify elderly patients who would benefit from endovascular repair of aortic aneurysms.
• To optimize treatment decisions for supra-threshold aortic aneurysms in the aging population.

Main Methods:

• Review of existing literature on EVAR in elderly populations.
• Analysis of cost-effectiveness and complication rates of EVAR versus open repair.
• Consideration of post-intervention surveillance and re-intervention impacts on quality of life.

Main Results:

• EVAR demonstrates no long-term longevity gains compared to open surgery.
• Elderly patients (over 80) experience higher mortality rates with EVAR.
• Complications like endoleak and the need for re-intervention negatively impact EVAR's cost-effectiveness and quality of life.

Conclusions:

• There is a significant need for improved risk stratification tools for elderly patients undergoing EVAR.
• Optimizing EVAR selection in octogenarians is essential given population aging.
• Further research is required to determine appropriate candidates for EVAR among the elderly.