February 18, 2020

Japanese Study Supports EVAR for Ruptured AAA in Octogenarian Patients With Suitable Anatomy

February 18, 2020—Findings from a nationwide, registry-based Japanese study of the impact of endovascular aneurysm repair (EVAR) on the outcomes of octogenarians with ruptured abdominal aortic aneurysms (rAAAs) were published by Tetsuo Yamaguchi, MD, et al in European Journal of Vascular and Endovascular Surgery (EJVES; 2020;59:219–225).

The retrospective, comparative study used data from the Japanese Registry of All Cardiac and Vascular Diseases–Diagnostic Procedure Combination (JROAD-DPC). JROAD-DPC is the nationwide, claim-based database from more than 600 hospitals.

As summarized in EJVES, the study’s primary endpoint was in-hospital mortality; the secondary endpoint was functional status at discharge. The study included patients in JROAD-DPC admitted with rAAA between April 1, 2012, and March 31, 2015, and compared patient characteristics, management, and outcomes between those ≥ 80 years with those < 80 years.

The investigators reported that 49.9% of the 3,969 eligible patients were categorized as elderly. Elderly patients compared with younger patients had a higher prevalence of female sex (41.8% vs 17%; P < .001) and a higher prevalence of disturbance of consciousness on admission (28.6% vs 20.7%; P < .001).

Elderly patients were less likely to undergo open surgical repair (31.6% vs 56.7%; P < .001) but were approximately as likely to undergo EVAR (13.7% vs 14.8%; P = .33). The unadjusted mortality rate (61.8% vs 37.6%; P < .001) and mean Barthel index at discharge (73.0 vs 91.8; P < .001) were statistically significantly worse in the elderly.

Multilevel mixed-effect logistic regression analyses showed that older age was detected as an independent predictor of in-hospital death (odds ratio, 2.75; 95% confidence interval, 2.39–3.17; P < .001). However, for patients who underwent EVAR, older age was not statistically significant (odds ratio, 1.13; 95% confidence interval, 0.77–1.66; P = .53).

The study showed that elderly patients with rAAA were less likely to be offered open surgical repair, and mortality among those who underwent surgery was high. However, for the small subgroup of elderly patients currently selected for EVAR, there was a favorable outcome. The further implementation of EVAR for rAAA in Japan, especially for elderly patients with suitable anatomy, may be justified, concluded the investigators in EJVES.


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