Favorable Outcomes in Octogenarians with Hostile Neck undergoing Endovascular Repair using EndoAnchors.

OBJECTIVES Standard endovascular repair (EVAR) is not suitable in patients with hostile aortic anatomy. Open aneurysm repair (OAR) has been the gold-standard approach in managing these patients. EndoAnchors have been introduced as a technique to make EVAR in patients with short and angulated necks possible. The use of EndoAnchors in managing hostile aneurysms in octogenarians has not been studied before. Thus, the purpose of this study is to evaluate both short and long-term outcomes in octogenarians versus non-octogenarians patients with hostile aortic anatomy undergoing EVAR using EndoAnchors. METHODS Only patients enrolled in the primary arm of the ANCHOR registry were included and stratified into octogenarians (80-89 years) and non-octogenarians (<80 years). Standard univariate (chi-square, fisher's exact, student's t-tests) and multivariable (logistic, cox-regression) analysis was used to evaluate patients' characteristics and outcomes between octogenarians versus non-octogenarians as appropriate. RESULTS Of 461 patients, 21% (N=97) were octogenarians. Compared to non-octogenarians, octogenarians were more likely to have a history of renal (32.0% vs. 18.4%) and genitourinary (30.9% vs. 21.2%) disease (both P<0.05). They were also more likely to have an AAA diameter greater than 55mm compared to non-octogenarians (59% vs. 46%), had increased neck tortuosity index [mean(S.D.) 1.07(0.08) vs. 1.05(0.05)], greater proximal neck angulation [mean(S.D.): 28.2(17.3) vs. 23.7(16) degrees] and were more likely to have localized (29.3% vs. 18.7%) and diffuse (25.6% vs. 20.7%) neck calcification (All P<0.05). The overall procedural success was similar between both groups. However, octogenarians had higher rates of endoleaks at completion (32.0% vs. 21.2%, P=0.03) and 30-day bleeding (12.4% vs. 5.8%) and cardiac (13.4% vs. 5.2%) complications (All P<0.05). Additionally, compared to non-octogenarians, octogenarians had lower freedom from all-cause mortality (87.90% vs. 96.50%) and type II endoleak (73.30% vs. 88.60%) based on Kaplan Meier estimates through one year (Both P<0.05). In multivariable cox-regression analysis, octogenarians demonstrated a 5-fold increase in all cause mortality [HR(95%CI): 5.19(1.92-14), P=0.001] and a 3-fold increase in type II endoleak [HR(95%CI): 2.99(1.54-5.81), P=0.001] at 1-year. However, no significant difference was seen in aneurysm/device related mortality [HR(95%CI): 1.42(0.14-14.7), P=0.77] and type I endoleak [HR(95%CI): 1.71(0.31-9.55), P=0.54] at 1-year. CONCLUSION Despite a worse aortic neck anatomy, octogenarians undergoing EVAR using EndoAnchors showed acceptable short and long-term outcomes. The results of our study could expand the utilization of EVAR in octogenarians with hostile neck.