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Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994-2014

Sonesson, B. LU ; Björses, K. LU ; Dias, N. LU ; Rylance, R. LU ; Mani, K.; Wanhainen, A. and Resch, T. LU (2017) In European Journal of Vascular and Endovascular Surgery 53(5). p.656-662
Abstract

Objective: To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994-2014. Material and methods: 2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared... (More)

Objective: To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994-2014. Material and methods: 2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared using log-rank tests. The multivariate Cox model was used for adjusting for confounding factors between open repair (OR) and endovascular aneurysm repair (EVAR). Results: Crude survival after rAAA repair was 30 days (55%), 90 days (50%), 1 year (45%), 5 years (26%), and 10 years (9%). Long-term survival was 1 year (90%), 5 years (53%), and 10 years (18%). When individuals with rAAA were categorized into males and females, crude and long-term survival showed no significant differences (p = .204 and p = .134). When rAAA patients were categorized into age groups (80-84 years, 85-89 years, 90+) crude survival diminished with increasing age, but long-term survival was not (p = .009 and p = .368). Compared with the general population, rAAA patients showed only a minor decrease in relative survival. Crude survival after rAAA was better for EVAR compared with OR (p = .007), hazard ratio 1.3 (95% CI 1.1-1.6, p < .012). Conclusions: There is a high (50%) peri-operative mortality after surgery for rAAA in octo- and nonagenarians, with no significant differences between the sexes and worse survival with increasing age. However, if a patient has survived the initial 90 days, long-term survival in this very old cohort is surprisingly good at more than 50% after 5 years, only slightly less than the general population.

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author
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Endovascular aneurysm repair, Octo- and nonagenarians, Open repair, Outcome, Ruptured abdominal aortic aneurysm
in
European Journal of Vascular and Endovascular Surgery
volume
53
issue
5
pages
656 - 662
publisher
Elsevier
external identifiers
  • scopus:85016006126
ISSN
1078-5884
DOI
10.1016/j.ejvs.2017.02.010
language
English
LU publication?
no
id
4d724162-14d7-46d6-a751-a3fd5583c630
date added to LUP
2017-04-19 13:34:30
date last changed
2018-01-07 11:59:43
@article{4d724162-14d7-46d6-a751-a3fd5583c630,
  abstract     = {<p>Objective: To report the outcome after ruptured abdominal aortic aneurysm (rAAA) repair in octo- and nonagenarians from the Swedish Vascular Registry 1994-2014. Material and methods: 2335 intact AAA (iAAA) and 1538 rAAA were identified in patients aged 80 years and older. Crude, long-term, and relative survival data were analysed using the Kaplan-Meier method. Crude survival was calculated including all deaths. Long-term survival was analysed excluding AAA repair related mortality, defined as death within 90 days of surgery. Relative survival was assessed by comparing the observed long-term survival after AAA repair with the expected survival of a Swedish population adjusted for age, gender, and operation year. Differences were compared using log-rank tests. The multivariate Cox model was used for adjusting for confounding factors between open repair (OR) and endovascular aneurysm repair (EVAR). Results: Crude survival after rAAA repair was 30 days (55%), 90 days (50%), 1 year (45%), 5 years (26%), and 10 years (9%). Long-term survival was 1 year (90%), 5 years (53%), and 10 years (18%). When individuals with rAAA were categorized into males and females, crude and long-term survival showed no significant differences (p = .204 and p = .134). When rAAA patients were categorized into age groups (80-84 years, 85-89 years, 90+) crude survival diminished with increasing age, but long-term survival was not (p = .009 and p = .368). Compared with the general population, rAAA patients showed only a minor decrease in relative survival. Crude survival after rAAA was better for EVAR compared with OR (p = .007), hazard ratio 1.3 (95% CI 1.1-1.6, p &lt; .012). Conclusions: There is a high (50%) peri-operative mortality after surgery for rAAA in octo- and nonagenarians, with no significant differences between the sexes and worse survival with increasing age. However, if a patient has survived the initial 90 days, long-term survival in this very old cohort is surprisingly good at more than 50% after 5 years, only slightly less than the general population.</p>},
  author       = {Sonesson, B. and Björses, K. and Dias, N. and Rylance, R. and Mani, K. and Wanhainen, A. and Resch, T.},
  issn         = {1078-5884},
  keyword      = {Endovascular aneurysm repair,Octo- and nonagenarians,Open repair,Outcome,Ruptured abdominal aortic aneurysm},
  language     = {eng},
  month        = {03},
  number       = {5},
  pages        = {656--662},
  publisher    = {Elsevier},
  series       = {European Journal of Vascular and Endovascular Surgery},
  title        = {Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994-2014},
  url          = {http://dx.doi.org/10.1016/j.ejvs.2017.02.010},
  volume       = {53},
  year         = {2017},
}