title: Thirty-day outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians based on the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE).
abstract: OBJECTIVE
  To determine 30-day outcome and quality of life after elective endovascular abdominal aortic aneurysm repair in octogenarians.
  
  
  METHODS
  From March 2009 to May 2011, 1200 patients with abdominal aortic aneurysms were treated with endovascular aneurysm repair (EVAR) using the Endurant stent graft were included in the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) registry. Among these, 926 (77%) were aged <80 years, and 274 (23%) were aged ≥ 80 years. Quality of life was assessed using composite EuroQoL 5-Dimensions Questionnaire index scores.
  
  
  RESULTS
  Gender was unequally distributed, with more female patients among the octogenarians (P = .043). Octogenarians had a significantly higher American Society of Anesthesiologists classification (P < .001) and differed significantly in baseline risk factors. The younger cohort was more likely to smoke (P < .001) and be alcoholics (P = .005). Octogenarians had larger aortic aneurysm (P = .010) and left iliac artery diameters (P = .017) and greater infrarenal neck angulation (P = .01). The technical success rate was >99% for both cohorts. Octogenarians were more often operated on under general anesthesia (P = .028), had a longer procedure duration (P = .001), and an increased length of hospitalization; both total (P < .001) and postprocedure (P < .001). All-cause mortality and major adverse event rates were similar in the two groups (P = .835 and P = .186, respectively). There was no difference in the number of secondary endovascular procedures or aneurysm rupture at 30 days. At discharge, both groups had reduced health status dimensions, except anxiety/depression, when compared with baseline. At 30 days, the octogenarian group had a lower composite EuroQoL 5-Dimensions Questionnaire index compared with the younger group, indicating a slower recovery (0.83 ± 0.20 vs 0.87 ± 0.16; P = .003).
  
  
  CONCLUSIONS
  Octogenarians can be safely treated using the Endurant stent graft with a high technical rate of success, low perioperative mortality, and no reduction in quality of life. Octogenarians did, however, appear to recover more slowly than younger patients with respect to certain quality of life components. Long-term data are needed to confirm these results.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pol
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: Steven M M
authors.initials: SM
authors.lastname: van Sterkenburg
authors.forename: Michel M P J
authors.initials: MM
authors.lastname: Reijnen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D018709:Statistics, Nonparametric; D015607:Stents; D011795:Surveys and Questionnaires; D016896:Treatment Outcome