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• W3021621612 abstract "As the population continues to age, vascular surgeons will continue to be confronted with the difficult problem of treating increasingly elderly patients. In this article, the authors address the issue of endovascular abdominal aortic aneurysm repair (EVAR) in nonagenarians, a population of patients clearly expected to increase in the coming decades. The data from their report can be used to both support and refute the wisdom of performing EVAR in patients in their ninth decade. Although procedural results were “acceptable,” to use the authors' word, perioperative morbidity (25%) and mortality (8.3%) were much higher than what we have come to expect from EVAR in the general population. Ultimately, >20% of the patients died as a direct result of the aneurysm or the repair, so it is not clear that EVAR in this patient group has improved the natural history of the disease. Furthermore, one has to question the wisdom of extending expensive health care resources to patients with limited life expectancy, only 19% at 5 years in this study. It must always be kept in mind that elective EVAR is a prophylactic operation for an asymptomatic condition. From a public health standpoint, it is questionable whether the cost/benefit ratio pencils out in this scenario. On the other hand, all vascular surgeons have seen and treated the “vigorous” nonagenarian whose health and quality of life defy their chronologic age. Although, as one of my mentors once told me, they may not look 90 before their operation, they always look 90 afterward. Clearly, though, there exists a subset of nonagenarians for whom EVAR is appropriate. Unfortunately, the numbers treated in this study were not large enough to stratify patients to determine factors predicting good and poor outcomes. Given the rarity of this procedure in nonagenarians, it is unlikely that a single center would be able to do so, and pooled data from multiple centers may be necessary to answer this question and identify nonagenarians for whom this procedure is most appropriate. The authors are to be congratulated for critically analyzing and presenting their results in this difficult group of patients. The conclusions are open to debate, and this article does not provide a definitive answer; however, it does serve as a point of comparison for future studies that address this issue. Outcome of elective endovascular abdominal aortic aneurysm repair in nonagenariansJournal of Vascular SurgeryVol. 54Issue 2PreviewCompared with open repair of abdominal aortic aneurysms (AAA), endovascular repair (EVAR) is associated with decreased perioperative morbidity and mortality in a standard patient population. This study sought to determine if the advantage of EVAR extends to patients aged ≥90 years. Full-Text PDF Open Archive" @default.
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• W3021621612 date "2011-08-01" @default.
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• W3021621612 title "Invited commentary" @default.
• W3021621612 doi "https://doi.org/10.1016/j.jvs.2011.01.004" @default.
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