Outcomes in Octogenarians Offered EVAR and Electing for Conservative Management: A Retrospective Cohort Study

Area of Science:

• Vascular Surgery
• Geriatric Medicine
• Clinical Outcomes Research

Background:

• Conservative management of abdominal aortic aneurysms (AAA) historically has poor outcomes.
• Limited contemporary data exists on premature mortality risk in elderly patients with AAA who are unfit for or decline intervention.
• Octogenarians present unique challenges in balancing intervention risks with aneurysm rupture probability.

Purpose of the Study:

• To investigate long-term survival differences between elective endovascular aneurysm repair (EVAR) and conservative management in octogenarians with above-threshold AAA.
• To compare outcomes for elderly patients fit for EVAR but self-selecting conservative management versus those undergoing EVAR.
• To inform shared decision-making for octogenarians with AAA.

Main Methods:

• Retrospective cohort study of octogenarians with infrarenal AAA considered for EVAR (2010-2024).
• Propensity score matching was used to compare outcomes between elective EVAR and conservative management groups.
• Exclusion criteria included age <80, consideration for open repair, and non-elective procedures.

Main Results:

• After propensity-score matching, EVAR offered only a marginal survival benefit (152 days) over conservative management (P=.13).
• Conservative management of AAA <6cm was associated with significantly longer survival (3.73 years) compared to larger aneurysms (2.26 years, P=.003).
• Patients self-selecting conservative management exhibited lower mortality than reported in historical literature.

Conclusions:

• Elective EVAR in octogenarians with AAA does not confer a statistically significant long-term survival advantage over conservative management.
• AAA size >6cm is a significant predictor of shorter survival in this elderly cohort.
• Findings support individualized shared decision-making, highlighting the marginal benefit of EVAR and the importance of non-aneurysm-related mortality in octogenarians.