title: Laparoscopy versus EVAR for the treatment of abdominal aortic aneurysms in the octogenarian.
abstract: BACKGROUND
  Octogenarians are considered at high surgical risk for the treatment of abdominal aortic aneurysms (AAA). The laparoscopic aortic surgery (LAS) and the endovascular treatment (EVAR) are 2 minimum invasive techniques whose objective is to limit the operative traumatism. The objective of this study was to compare our results with short- and medium-term results with these 2 techniques in the octogenarians.
  
  
  METHODS
  Between January 2002 and December 2012, the data of 674 operated consecutive AAA (315 LAS, 172 EVAR, and 187 open surgeries) were collected prospectively. Eighty-seven patients aged ≥80 years presenting a favorable anatomy were treated by LAS or EVAR. Twenty-five patients aged ≥85 years with a favorable anatomy were excluded because we generally did not propose LAS to them. Statistical analysis compared the demographic data and the results of the 2 groups. The principal criterion of judgment (PCJ) was the combined rate of mortality and severe systemic complications (MSSC) at 30 days. An uni/multivariate model was used to determine the factors associated with the occurrence of the PCJ. The data were expressed as means and standard deviations. A P value ≤0.05 was considered significant.
  
  
  RESULTS
  Sixty-two patients (90% men, age 81.8 ± 1.4 years) were included. There were 31 EVAR and 31 LAS. The 2 groups were comparable concerning the demographic data, the comorbidities, and the aneurysmal anatomies. There was a nonsignificant tendency to higher rates of mortality (9.7 vs. 3.2%, P = 0.3) and MSSC at 30 days (16.1 vs. 3.2%, P = 0.09) in the LAS group. During the operation, LAS was associated with a longer operative time (289 ± 85 vs. 152 ± 57 min, P < 0.0001), more blood losses (1,073 ± 763 vs. 148 ± 194 mL, P < 0.0001), and more transfusions (2.0 ± 3.0 vs. 0.9 ± 1.1 units, P = 0.048). In the postoperative period, the patients operated by LAS had longer reanimation and hospitalization stays (12.9 ± 13.1 vs. 7.0 ± 2.5 days, P = 0.02; and 3.3 ± 4.4 vs. 0.6 ± 0.7 days, P = 0.002; respectively). However, in multivariate analysis, an operative duration >300 min was the only variable associated with the PCJ (P = 0.05). With a follow-up of 9.0 ± 10.7 month, there were 2 reinterventions in the EVAR group, whereas with a follow-up of 38.0 ± 23.9 month, no reintervention was observed in the LAS group.
  
  
  CONCLUSIONS
  In the short run, EVAR significantly reduces the operative traumatism in comparison with LAS in the octogenarian presenting an AAA with a favorable anatomy. However, the choice of the technique is not independently predictive of MSSC at 30 days. When a durable repair is desirable, LAS remains a possible option in the octogenarian with a good general condition presenting a favorable aneurysmal anatomy.
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France; Simone Veil Health Sciences Faculty, University of Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Coscas
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France; Simone Veil Health Sciences Faculty, University of Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Dennery
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France; Simone Veil Health Sciences Faculty, University of Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Javerliat
authors.affiliation: Vascular Surgery Unit, Foch Hospital, Suresnes, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Di Centa
authors.affiliation: Simone Veil Health Sciences Faculty, University of Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France; Department of Geriatrics, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France.
authors.forename: Tristan
authors.initials: T
authors.lastname: Cudennec
authors.affiliation: Simone Veil Health Sciences Faculty, University of Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France; Department of Geriatrics, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Teillet
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France; Simone Veil Health Sciences Faculty, University of Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Goëau-Brissonniere
authors.affiliation: Department of Vascular Surgery, Ambroise Paré University Hospital, AP-HP, Boulogne-Billancourt, France; Simone Veil Health Sciences Faculty, University of Versailles Saint-Quentin en Yvelines, Montigny-le-Bretonneux, France. Electronic address: mpcoggia@aol.com.
authors.forename: Marc
authors.initials: M
authors.lastname: Coggia
mesh_terms: D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D015897:Comorbidity; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D012307:Risk Factors; D016896:Treatment Outcome