The Effect of Age on Peri-Operative Outcomes after FEVAR

Abstract

Introduction: Fenestrated endovascular aortic repair (FEVAR) has become a popular custom-made treatment option for juxtarenal and pararenal aneurysms. It has been previously investigated whether octogenarians as a distinct subgroup are at increased risk for adverse outcomes after FEVAR. With diverging results and an inconclusive understanding of age as a risk factor in general, an analysis of the historical data of a single center was conducted to add to the available body of evidence and further investigate the effect of age as a continuous risk factor.

Methods: A retrospective data analysis of a prospectively maintained single-center database of all patients who underwent FEVAR at a single department of vascular surgery was performed. The main endpoint was post-operative survival. In addition to association analyses, potential confounders such as co-morbidities, complication rates, or aneurysm diameter were examined. In terms of sensitivity analyses, logistic regression models were created for the dependent variables of interest.

Results: During the observation period from April 2013 to November 2020, 40 patients over the age of 80 and 191 patients under the age of 80 were treated by FEVAR. The 30-day survival showed no significant difference between the groups (95.1% in octogenarians and 94.3% in patients under 80 years of age). The sensitivity analyses conducted also showed no difference between the two groups, and complication and technical success rates were comparable. The aneurysm diameter was 67 ± 13 mm in the study group and 61 ± 15 mm in those under 80 years of age. Additionally, the sensitivity analyses showed that age as a continuous variable exhibits no effect on the outcomes of interest.

Discussion: In the present study, age was not associated with adverse peri-operative outcomes after FEVAR, including mortality, lower technical success rates, complications, or length of hospital stay. Essentially, the most highly associated factor with hospital and ICU length of stay was time spent in surgery. However, octogenarians had a significantly larger aortic diameter at the time of treatment, which might indicate the potential introduction of bias by pre-interventional patient selection. Nevertheless, the usefulness of research on octogenarians as a distinct subgroup might be questionable regarding the scalability of results, and future studies might focus on age as a continuous risk factor instead.

Keywords: FEVAR; aortic aneurysm; endovascular aortic repair; juxtarenal; octogenarians; pararenal.

Figure 1

Comparative analysis of octogenarians and non-octogenarians regarding maximum aneurysm diameter (A), days spent in the hospital after surgery (B), days spent in intensive care after surgery (C), as well as time in surgery (primary procedure) (D) (AAA = abdominal aortic aneurysm). Turquoise line indicates group means.

Figure 2

Conducted association analyses of age and hospital (A) as well as intensive care unit (ICU) stay (B), and time in surgery and hospital (C) as well as ICU length of stay (D). The turquoise line depicts a linear regression, and the shaded grey area is the corresponding 95% CI. R equals the Pearson correlation coefficient with the associated p-value.