[Efficacy and safety analysis of endovascular aortic repair of abdominal aortic aneurysms in patients over eighty years old].

OBJECTIVE: To evaluate the outcome of the endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) in patients over 80 years old and analyze the factors that influence its long-term curative effect. METHODS: Follow-up visits and analysis were conducted from January 2004 to December 2013 on a total of 96 AAA patients aged over 80 years old who had been treated with EVAR and thus met the inclusion criteria. The primary focus of the study was all-cause mortality and secondary focuses included the rate of intervention-related complications, the rate of secondary interventions and procedural data. The Kaplan-Meier survival curve was used to analyze the long-term survival rate and the cumulative probability of intervention-related complications. The Cox proportional hazards regression model was used to analyze factors that could influence the long-term survival rate. RESULTS: Effective follow-up visits were conducted on 76 patients (79.2%). The patients were tracked for an average of 3.63 years, with the longest follow-up lasting 10.34 years. During the study, 27 deaths occurred and the all-cause mortality rate was 28.1%. Furthermore, 8 cases of intervention-related complications (8.3%) were observed, including endoleaks and spinal cord ischemia. A total of 6 secondary interventions were conducted on 6 patients, with the rate of secondary interventions being 6.3%. The five-year cumulative survival rate was 64% (95%CI: 0.53-0.78) and the ten-year cumulative survival rate was 35%(95%CI: 0.15-0.84). The Cox proportional hazards model showed that an ASA classification of Ⅲ/Ⅳ (HR=8.45, 95%CI: 1.26-56.55, P<0.05), smoking (HR=2.08, 95%CI: 0.70-2.63, P<0.05) and cerebrovascular diseases (HR=2.96, 95%CI: 1.06-8.25, P<0.05) could significantly increase the risk of the long-term all-cause mortality of an AAA patient treated with EVAR. While hypertension could significantly decrease the risk (HR=0.25, 95%CI: 0.10-0.66, P<0.05). CONCLUSION: EVAR is safe for senior patients with AAA though personalized preoperative assessment is very important.

[Endovascular aortic repair of infrarenal abdominal aortic aneurysm: a 10-year single center outcomes].

OBJECTIVE: To evaluate the outcome after endovascular aortic repair (EVAR) of abdominal aortic aneurysms (AAA) in single center. METHODS: A total of 711 AAA patients treated by EVAR in Department of Vascular Surgery, People's Liberation Army General Hospital and met the inclusion criteria from January 2004 to June 2014 were followed-up and analyzed. There were 612 male and 99 female patients, with a mean age of (69±13) years in this study group. The primary outcome of the study was all-cause mortality, secondary outcome included procedural data, intervention-related morbidity and secondary therapeutic procedures. The endpoint was death. Kaplan-Meier survival analysis were used to analyze long-term survival and cumulative probability of intervention related morbidity. Cox proportional hazards regression was used to analyze factors influenced the survival. Multivariable analysis were adjusted for covariates. RESULTS: There were 74.8% of total patients followed up. The longest follow-up period was 10.4 years (mean 3.8 years). For the primary outcome of all-cause mortality, 140 deaths occurred. Intervention related morbidity was 9.3%, secondary therapeutic procedures was 5.3%.The Kaplan-Meier survival curve showed that cumulative survival is 78% (95% CI: 74% to 82%) in 5 years, 67% (95% CI: 61% to 74%) in 10 years and the cumulative probability of intervention related morbidity is 10.5% (95% CI: 7.3% to 13.7%) in 5 years, 19.3% (95% CI: 11.9% to 26.0%) in 10 years. Cox proportional hazards regression showed that age>75 years, American Society of Anesthesiologists classification III or IV, smoking, diabetes significantly increase the risk of long-term all-cause mortality, while hypertension significantly decreases the risk. CONCLUSIONS: Long-term outcome after EVAR of AAA in the study is similar to those advanced studies.The management of risk factors would improve the prognosis of these patients.