• Sérgio Teixeira Centro Hospitalar do Porto - Hospital Santo António
  • Rui Machado Centro Hospitalar do Porto - Hospital Santo António; Instituto de Ciências Biomédicas Abel Salazar - ICBAS
  • Pedro Sá Pinto Centro Hospitalar do Porto - Hospital Santo António
  • Rui Almeida Centro Hospitalar do Porto - Hospital Santo António; Instituto de Ciências Biomédicas Abel Salazar - ICBAS
Keywords: EVAR, abdominal aortic aneurysm, nonagenarians


Introduction: Advanced age negatively impacts the outcomes of abdominal aortic aneurysm (AAA) repair. Nowadays, endovascular procedures enable vascular surgeons to treat elderly patients who cannot be submitted to open surgery. Aims: We report our experience with endovascular aneurysm repair (EVAR) in nonagenarians.

Methods: We retrospectively reviewed our prospectively maintained aneurysm database in order to obtain records of all patients more than 90 years-old, who were submitted to EVAR over a 12 years period at our institution. Patients’ comorbidities, functional status, aneurysm size, perioperative complications, endoleaks, reinterventions and long-term survival were recorded.

Results: 171 EVAR procedures were performed. Three (1,75%) nonagenarians underwent aneurysm repair (3 male; mean age 91.3 ± 1.25 years). Mean aneurysm diameter was 8.2 ± 1.68 cm with a median size of 8.1 cm (range 6.2–10.3 cm). There were 1.7 mean comorbidities per patient. Technical success rate was 100%. Mean hospital length of stay was 4.3 ± 0.47 days with a median of 4 days (range 4–5 days). Thirty-day mortality was 0%. Mean follow-up and mean survival were 28 months. There were no complications and all patients returned to their preoperative functional status. No endoleaks were identified on the follow-up imaging.

Conclusions: We have shown, in a small and carefully selected group, that EVAR is associated with good outcomes in nonagenarian patients. EVAR is, in our opinion, the best treatment option for AAA in nonagenarians with good functional status.


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1. Manton KG. Recent declines in chronic disability in the elderly U.S.
population: risk factors and future dynamics. Annu Rev Public
Health. 2008;29:91–113.
2. Heron M, Hoyert DL, Murphy SL, et al. Deaths: final data for 2006.
Natl Vital Stat Rep 2009. 2009;57(14):1–134.
3. Lee GK, Ullery BW, Lee JT. Elective EVAR in nonagenarians is safe
in carefully selected patients. Ann Vasc Surg. 2014;28(6):1402–8.
4. Norman PE, Semmens JB, Lawrence-Brown MM, Holman CD.
Long term relative survival after surgery for abdominal aortic
aneurysm in western Australia: population based study. BMJ.
5. Goldstein LJ, Halpern JA, Rezayat C, et al. Endovascular aneurysm
repair in nonagenarians is safe and effective. J Vasc Surg.
6. Roberts WC, Ko JM, Pearl GJ. Abdominal aortic aneurysm in nonagenarians.
Am J Geriatr Cardiol. 2006;15(5):319–21.
7. Bouwmeester MF, van Sterkenburg SM, Zeebregts CJ, et al. Endovascular
abdominal aortic aneurysm repair in nonagenarians--beyond
limits? Tex Heart Inst J. 2009;36(4):345–8.
8. Geisbusch P, Katzen BT, Tsoukas AI, et al. Endovascular repair of
infrarenal aortic aneurysms in octogenarians and nonagenarians.
J Vasc Surg. 2011;54(6):1605–13.
9. Raval MV, Eskandari MK. Outcomes of elective abdominal aortic
aneurysm repair among the elderly: endovascular versus open
repair. Surgery. 2012;151(2):245–60.
10. Chaikof EL, Brewster DC, Dalman RL, et al. The care of patients
with an abdominal aortic aneurysm: the Society for Vascular
Surgery practice guidelines. J Vasc Surg. 2009;50(4 Suppl):S2–49.
11. Lederle FA, Johnson GR, Wilson SE, et al. Rupture rate of large
abdominal aortic aneurysms in patients refusing or unfit for elective
repair. JAMA. 2002;287(22):2968–72.
12. Tsilimparis N, Perez S, Dayama A, Ricotta JJ, 2nd. Age-stratified
results from 20,095 aortoiliac aneurysm repairs: should we
approach octogenarians and nonagenarians differently? J Am Coll
Surg. 2012;215(5):690–701.
13. Jim J, Sanchez LA, Sicard GA, et al. Accep risk but small benefit of
endovascular aneurysm repair in nonagenarians. Ann Vasc Surg.
14. Baril DT, Palchik E, Carroccio A, et al. Experience with endovascular
abdominal aortic aneurysm repair in nonagenarians. . J Endovasc
Ther. 2006;13(3):330–7.
15. Prenner SB, Turnbull IC, Malik R, et al. Outcome of elective endovascular
abdominal aortic aneurysm repair in octogenarians and
nonagenarians. J Vasc Surg. 2010;51(6):1354–9.
16. Timaran CH, Veith FJ, Rosero EB, et al. Endovascular aortic aneurysm
repair in patients with the highest risk and in-hospital
mortality in the United States. Arch Surg. 2007;142(6):520–4;
discussion 4–5.
17. Bettex DA, Lachat M, Pfammatter T, et al. To compare general,
epidural and local anaesthesia for endovascular aneurysm repair
(EVAR).Eur J Vasc Endovasc Surg. 2001 Feb;21(2):179–84.
18. Buck DB, Karthaus EG, Soden PA, et al. Percutaneous versus
femoral cutdown access for endovascular aneurysm repair. J Vasc
Surg. 2015 Jul;62(1):16–21.
Original Article