Composite Outcomes to Improve Patient Selection in Octogenarians Undergoing Juxtarenal Abdominal Aortic Aneurysm...

Juxtarenal abdominal aortic aneurysms (JRAAAs) represent 16% of all AAAs and pose challenges due to their proximity to the renal arteries. Standard endovascular aneurysm repair (EVAR) is unsuitable, necessitating advanced techniques such as fenestrated EVAR (FEVAR) and chimney EVAR (ChEVAR), which carry increased risks. Octogenarians are an expanding demographic, but evidence on JRAAA repair outcomes in this group is limited. This study evaluates outcomes of JRAAA repair in octogenarians using data from the Dutch Surgical Aneurysm Audit (DSAA).

This nationwide retrospective cohort study analyzed DSAA data on elective JRAAA repairs (2016-2023). Outcomes in octogenarians were compared between open surgical repair (OSR) and complex EVAR (cEVAR). In addition, outcomes in octogenarians were compared with those in nonoctogenarians, stratified by treatment modality. The primary endpoints were textbook outcome (TO) and failure-to-rescue (FTR); secondary endpoints included 30-day mortality and postoperative complications.

Among 1,655 patients, 237 (14%) were octogenarians. Octogenarians had TO in 57% of cases, with higher rates following cEVAR than OSR (66% vs. 41%; P = 0.010). Complication rates were significantly lower with cEVAR (24% vs. 53%; P < 0.001), as were intensive care unit (ICU) admissions (38% vs. 89%; P < 0.001). FTR occurred in 7%, and 30-day mortality rates did not differ significantly between cEVAR and OSR (6% vs. 9%; P = 0.072).

Octogenarians undergoing JRAAA repair are at greater risk of dying and experiencing complications compared to nonoctogenarians. cEVAR demonstrates fewer complications, reduced resource utilization, and more favorable perioperative outcomes compared to OSR, supporting its role as a safer alternative. Individualized risk assessment and further research on predictive models and cost-effectiveness are crucial for optimizing management in this high-risk group.