In recent years, treatment of abdominal aortic aneurism (AAA) in nonagenarians has become more frequent. However, the number of patients is small, and there are few published data, especially with regard to the long-term results, with one study reporting long-term survival on a national basis (1), and another large national study reporting inpatient outcomes (2). This study reports national results for treatment of AAA in nonagenarians in Norway for the 7-year period 2015 - 2021.

All patients operated for AAA between 2015 and 2021 were identified from the national registry. 30-day mortality and long-term survival were calculated, based on data from the population registry. Estimates for mean and median survival and survival curves were calcutated with Kaplan-Meier analysis. Analysis was performed with SPSS.

We identified 77 patients aged 90 and over who were operated for AAA in the study period. Indication was asymptomatic AAA in 40 patients, symptomatic in 15 and ruptured AAA (RAAA) in 22. A total of 55 were operated with EVAR and 22 with open surgery. For comparison, survival was also analyzed in 4591 patients under 80 years and 1362 patients between 80 and 89 years. 30-day mortality was 2,5 % in asymptomatic patients, 33,3 % in symptomatic patients and 59,1 % in RAAA. For patients with asymptomatic AAA, the estimate for median survival in nonagenarians was 1178 days. For asymptomatic patients aged 80-89 years, the median survival was 1906 days. For asymptomatic patients under 80 years, the estimate for survival after 7 years is still about 70 %. Figure 1 shows the Kaplan-Meier estimated survival curves for asymptomatic patients. Median survival after operation for symptomatic AAA in nonagenarians was 1032 days, and after RAAA it was 24 days. Figure 2 shows survival for patients with RAAA.

Especially in asymptomatic patients, both perioperative mortality and survival support the current policy of treating AAA in selected nonagenarians. For symptomatic and ruptured AAA patients, 30-day mortality figures are much higher. However, those who survive the operation have an expected survival of several years, supporting treatment of symptomatic and ruptured AAA in nonagenarians, in case the patient is considered fit for the operation.

1.) Sonesson B, Björses K, Dias N, Rylance R, Mani K, Wanhainen A, Resch T.: Outcome After Ruptured AAA Repair in Octo- and Nonagenarians in Sweden 1994-2014. Eur J Vasc Endovasc Surg. 2017 May;53(5):656-662. 2.) Hughes K, Abdulrahman H, Prendergast T, Rose DA, Ongu'ti S, Tran D, Cornwell EE 3rd, Obisesan T, Amankwah KS. Abdominal aortic aneurysm repair in nonagenarians. Ann Vasc Surg. 2015 Feb;29(2):183-8.