Editor-in-Chief Ufuk Demirkılıç Frequency Quarterly Abbreviation Damar Cer Derg Publisher Turkish National Vascular and Endovascular Surgery Society ISSN 1301 - 1839 E-ISSN 2149 - 1259

Turkish Journal of Vascular Surgery 2017 , Vol 26 , Issue 3
Outcomes of endovascular aortic aneurysm repair in octogenarians with hostile iliac artery anatomy
Adnan Taner Kurdal1, Dilşad Amanvermez Şenarslan1, Funda Yıldırım1, Ahmet İhsan İşkesen1, Mustafa Cerrahoğlu1, Ömer Tetik1
1Department of Cardiovascular Surgery, Medicine Faculty of Manisa Celal Bayar University, Manisa, Turkey DOI : 10.5606/tjvs.2017.24 Objectives: This study aims to evaluate the outcomes following endovascular aortic aneurysm repair (EVAR) in octogenarian patients with hostile artery anatomy (HAA) and compare the one-year results of octogenarian patients with favorable artery anatomy (FAA) or HAA after EVAR.Patients and methods: Thirty-one consecutive octogenarian male patients (mean age 82±1.8 years; range 81 to 89) operated between January 2013 and January 2017 for abdominal aortic aneurysm (AAA) were analyzed retrospectively and divided into two groups as FAA or HAA. HAA was defined as presence of aneurysm at any point in iliac arteries (≥17 mm in males, ≥15 mm in females), severe (≥50%) artery stenosis, or severe tortuosity of iliac artery. Patients" demographic data, operation details, 30-day, and one-year outcomes were recorded.

Results: Of the 31 patients, 14 (45%) had HAA. Technical success for both groups was 100%. Type 1a endoleak was not seen on control angiography in both groups. More adjunctive intraoperative procedures were necessary for type 1b endoleaks in patients with HAA (p=0.019). Total usage of contrast agent was higher in HAA group (p=0.014). At 30-day follow-up, creatinine level was higher in HAA group (p=0.009). Four patients with HAA developed acute kidney failure (p=0.034). Durations of operation and hospital stay were longer in HAA group (p=0.041, p=0.019). At one-year follow up, no significant difference was found between two groups in all-cause mortality. Three patients with HAA still undergo dialysis for chronic renal failure (p=0.042).

Conclusion: Abdominal aortic aneurysm repairs were found to be associated with more requirement of adjunctive procedures, more contrast agent usage, higher creatinine levels, more frequent development of kidney failure, and prolonged duration of hospital stay in octogenarian patients with HAA compared to those with FAA. Keywords : Endovascular aneurysm repair; hostile artery anatomy; iliac artery; octogenarian