Australia & New Zealand Society of Vascular Surgeons

Operative treatment for abdominal aortic aneurysm (AAA) in octogenarians has traditionally been met with guarded enthusiasm. While robust octogenarians have been recognized to recover from conventional open AAA repair, most experienced vascular surgeons recognize that it is uncommon for an octogenarian to undergo such an operation and have full recovery back to baseline status. Recent technology of endovascular AAA repair (EVAR) has resulted in new enthusiasm in the management of AAA in the elderly. Since EVAR technology has been embraced and widely applied to patients with AAA, many reports have documented technical success of EVAR implants, their intermediate-term durability, and their complications. Little attention has been given to refine our knowledge of AAA and the benefit (or lack of benefit) patients receive from AAA repair. Questions regarding risks of rupture and rate of growth remain. Available data regarding risk of rupture are antiquated and difficult to apply to specific populations of AAA patients. Marginal, if any benefit from AAA repair has been demonstrated in both the UK small aneurysm trial and US veterans studies. Without clear benefit from AAA repair in the elderly, widespread repair of AAA with EVAR in this population may not be justified. Furthermore, costs of adding repair to a population previously felt unsuitable is substantial. While EVAR is likely the preferred method of AAA repair in the elderly, there is no basis for expanding indications for AAA repair with EVAR to a large group of octogenarians.