title: Endovascular aneurysm repair in nonagenarians: a systematic review.
abstract: BACKGROUND
  Endovascular aortic aneurysm repair (EVAR) has been associated with a reduction in early morbidity and mortality compared with open surgery, creating an opportunity for aneurysm repair in those previously considered unfit for intervention. We determine the published incidence of complications and survival after elective EVAR in nonagenarians.
  
  
  METHODS
  A systematic literature search was performed using the PubMed, EMBASE, and Cochrane databases up to December 2012. Two observers independently screened search results and extracted data.
  
  
  RESULTS
  Six retrospective reports were identified including 361 patients (81% men) with a mean age of 91.6 years. The mean aneurysm size was 69 mm. Comorbidities include hypertension (81%), ischemic heart disease (50%), peripheral vascular disease (30%), and chronic obstructive pulmonary disease (20%). There was no intraoperative mortality, 22% of patients had perioperative medical or surgical complications, and 24% had endoleaks. Mean duration of hospital stay was 4 days. Thirty-day mortality was 5%, and survival at 1, 3, and 5 years was 82%, 56%, and 17%, respectively.
  
  
  CONCLUSIONS
  Although the complication rates and longer term survival after elective EVAR in carefully selected nonagenarians appear acceptable, they are higher than those reported in younger patients. Given the typical life expectancy, careful consideration should be given to individual cases before undertaking EVAR in the nonagenarian.
authors.affiliation: Department of Surgery, University Hospital Southampton, Southampton, UK.
authors.forename: James
authors.initials: J
authors.lastname: Wigley
authors.affiliation: Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK; Division of Health Sciences, University of Warwick Medical School, Coventry, UK.
authors.forename: Saran
authors.initials: S
authors.lastname: Shantikumar
authors.affiliation: Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.
authors.forename: Waseem
authors.initials: W
authors.lastname: Hameed
authors.affiliation: Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Griffin
authors.affiliation: Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, UK.
authors.forename: Ashok
authors.initials: A
authors.lastname: Handa
authors.affiliation: Division of Cardiovascular and Diabetes Research, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK; Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK. Electronic address: d.j.a.scott@leeds.ac.uk.
authors.forename: D Julian A
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D057510:Endovascular Procedures; D006801:Humans