Projected Survival Benefit of Fenestrated Endovascular Aneurysm Repair versus Observation for Complex Abdominal Aortic Aneurysms in Patients with Limited Life Expectancy.

OBJECTIVES: Patients with limited life expectancy due to advanced age and/or comorbidities may not derive survival benefit from fenestrated endovascular aneurysm repair (FEVAR) of complex abdominal aortic aneurysms (AAAs). We estimated projected survival following FEVAR versus observation among patients with complex AAAs who had limited life expectancy and who were deemed unsuitable for open repair.

METHODS: We constructed a probabilistic Markov model to estimate projected survival among patients undergoing FEVAR versus observation. Baseline life expectancy was derived from the validated Lee score survival calculator. Patients underwent either FEVAR with risk of complications and death, or observation subject to aneurysm growth and rupture. We modeled aneurysms sized 5.5-8.5/5.0-8.5 cm in men/women, and Lee scores 7-14.

RESULTS: At 1 year, FEVAR had survival advantage for larger aneurysms (≥6.5 cm in men and ≥6.0 cm in women) regardless of Lee score. However, for smaller aneurysms and depending on Lee score (5.5 cm for all Lee scores or 6.0 cm with Lee score ≥10 in men; 5.0 cm for all Lee scores or 5.5 cm with Lee score ≥11 in women), FEVAR had lower 1-year survival. At 5 years, FEVAR had survival advantage regardless of Lee score or aneurysm size.

CONCLUSION: Among patients with complex AAAs that meet size criteria for repair, FEVAR has long-term survival advantage at 5 years, even when life expectancy is limited due to advanced age and/or comorbidities.