Long-term Outcomes of Fenestrated/branched Endovascular Aneurysm Repair in Octogenarians

We examined the perioperative, postoperative, and long-term outcomes of fenestrated/branched endovascular aneurysm repair (F/BEVAR) in octogenarians compared with nonoctogenarians. A retrospective analysis of the Vascular Quality Improvement database from 2012 to 2022 was performed. The included patients had undergone elective EVAR involving at least one visceral or renal artery, without arch involvement or subclavian repair. The patients were stratified into two groups: those aged <80 years and those aged ≥80 years. The preoperative, intraoperative, and postoperative factors were compared between the two groups. Primary outcome of interest included long-term all-cause mortality; secondary outcomes included aortic-specific mortality and aortic-specific reintervention. A total of 6007 patients (age <80 years, n = 4860; age ≥80 years, n = 1147) who had undergone F/BEVAR procedures were included. No significant difference was found in technical success, postoperative length of stay, length of intensive care unit stay, postoperative bowel ischemia, and spinal cord ischemia. Octogenarians were more likely to suffer from a postoperative complication (odds ratio [OR], 1.16; 95% confidence interval [CI], 0.98-1.37; P < .001), be discharged to a rehabilitation center (OR, 1.60; 95% CI, 1.27-2.00; P < .001) or nursing home (OR, 2.23; 95% CI, 1.64-3.01; P < .001). Nine-year survival was lower in octogenarians (82% vs. 69%; hazard ratio [HR], 1.70; 95% CI, 1.46-2.0; P < .0001) (Fig). Multivariate Cox proportional hazard analysis demonstrated that age was associated with increased all-cause mortality (HR, 1.72; 95% CI, 1.39-2.12; P < .001) and aortic-specific mortality (HR, 1.92; 95% CI, 1.04-3.68; P = .038). Crawford extent II aortic disease was associated with increase in all-cause mortality (HR, 1.49; 95% CI, 1.01-2.19; P < .001), aortic-specific mortality (HR, 5.05; 95% CI, 1.35-18.9; P = .016), and aortic-specific reintervention (HR, 1.91; 95% CI, 1.24-2.93; P = .003). Functional dependence was associated with increased all-cause mortality (HR, 2.90; 95% CI, 1.87-4.51; P < .001) and aortic-specific mortality (HR, 4.93; 95% CI, 1.69-14.4; P = .004). Our findings suggest that F/BEVAR in octogenarians is associated with periprocedural outcomes equivalent to those for younger patients but with a higher long-term all-cause mortality. Despite this, when adjusted for other risk factors, age is a moderate risk factor, and special consideration should be given to octogenarians with poor functional dependence and Crawford extent II aortic disease.