Balancing Risks and Clinical Outcomes of Endovascular Aneurysm Repair in Nonagenarians

Endovascular aortic repair (EVAR) is a viable option for elderly patients with abdominal aortic aneurysm. In extremely elderly individuals with inherently limited survival, this study aimed to evaluate EVAR outcomes in nonagenarians and identify factors associated with favorable survival to refine selection criteria.

We retrospectively analyzed 144 patients who underwent elective EVAR between April 2013 and August 2023. Patients were divided into those aged <90 years (younger group, n = 132) and ≥90 years (nonagenarian group, n = 12). Primary outcomes included postoperative morbidity and mortality. In addition, we explored potential risk factors for early mortality in the nonagenarian group.

There were no significant differences between the groups in 30-day (P = 0.840) aneurysm-related mortality (P = 0.769) or postoperative morbidity (P = 0.297). At 1 year, the survival rate was 67% in the nonagenarian group and 90% in the younger group (P = 0.116). While this difference was not significant, the overall Kaplan-Meier survival curve demonstrated a significant divergence between the two groups (P = 0.012). Four nonagenarians died within 1 year postoperatively. A Clinical Frailty Score ≥6 and the presence of dysphagia or chronic obstructive pulmonary disease were significantly associated with 1-year mortality (P = 0.034, 0.002). The survival of nonagenarians post-EVAR was comparable to an age- and sex-matched general Japanese population.

EVAR in nonagenarians resulted in favorable short-term outcomes with no early or aneurysm-related deaths. Their long-term survival approximated that of the general population, suggesting EVAR may offer comparable prognostic benefit. However, in patients with severe frailty or comorbidities, such as dysphagia or respiratory impairment, EVAR should be carefully considered.