Five Year Outcomes after Fenestrated Endovascular Aortic Repair in Octogenarians

Elderly patients are prone to complications in aortic surgery. Fenestrated endovascular aortic repair (FEVAR) can be used to treat complex abdominal aortic aneurysms (AAAs). We describe 5-year results with FEVAR using the Zenith Fenestrated device (ZFEN) in an elderly population.

This is a retrospective review of all FEVARs between January 2012 and August 2019 at a tertiary academic medical center. The study compared 60-month outcomes for patients younger than 79.9 (Group 1) and greater than 80.0 years (Group 2). The primary outcome was mortality. Secondary outcomes included reintervention and complications.

153 patients met inclusion criteria, 27 of whom were age ≥80.0 years and were included in Group 2. Group 1 had more active smokers at surgery (50.0% vs. 18.5%, P = 0.003) and higher body mass index (29.0 ± 6.1 vs. 25.4 ± 3.4, P = 0.004). The remaining baseline comorbid conditions and medications did not differ between groups. Length of stay (3.5 vs. 3.7 days, P = 0.88) and need for facility discharge did not differ (10.3% vs. 7.4%, P = 0.13). At 60 months, the estimated overall survival was not different between groups (66.7% Group 2 vs. 73.8% Group 1, P = 0.55). Estimated freedom from reintervention also did not differ at 60 months (81.5% Group 2 vs. 72.2% Group 1, P = 0.16).

FEVAR with ZFEN is safe and effective for the treatment of complex AAA in patients older than 80 years. Five-year outcomes, overall survival, and complications did not differ between groups, suggesting benefit of performing elective aneurysm repair in well selected elderly patients.