{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T16:12:42Z","timestamp":1785514362523,"version":"3.56.0"},"reference-count":50,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>Historically, conservative management of above-threshold abdominal aortic aneurysm (AAA) is associated with poor outcomes; however, there is limited contemporary data on risk of premature mortality in elderly patients either unfit for intervention or self-selecting conservative management. This exploratory study investigates whether amongst octogenarians deemed fit for endovascular aneurysm repair (EVAR), long-term survival differs for conservative management compared with elective EVAR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>The cohort comprised octogenarians with infrarenal AAA considered for EVAR in the Somerset and North Devon Vascular Network between 1 January 2010 to 1 January 2024. Exclusion criteria were age &lt;80, consideration for open repair, and nonelective procedures. Propensity score matching was performed to compare patients undergoing elective EVAR and self-selecting conservative management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      393 octogenarians were identified. Of them, 159 (40.3%) underwent EVAR, 190 (48.1%) were unfit for intervention, and 44 (11.6%) were offered EVAR but self-selected conservative management. Patients self-selecting conservative management were older (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001), had smaller aneurysms (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.048), and were less frequently male (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.182) than those undergoing EVAR. On unadjusted analysis, median survival was 2.01 years longer for EVAR patients (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u2009.001). After propensity-score matching, survival was 152 days longer for the EVAR group (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.13). Conservative management of AAA\u2009&lt;\u20096cm was associated with longer survival than larger aneurysms (3.73 vs 2.26 years,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009=\u2009.003). Patients self-selecting conservative management had lower mortality compared with the published literature.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In our cohort, octogenarians undergoing EVAR experience low periprocedural mortality, but no statistically significant difference in long-term survival was observed over patients self-selecting conservative management. An abdominal aortic aneurysm &gt; 6cm is associated with shorter survival. These results inform shared decision-making and support further investigation of treatment thresholds in octogenarians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>As the population ages an increasing number of octogenarians will be diagnosed with above-threshold AAA. Decision making for octogenarians with AAA is challenging, as procedure-related morbidity and mortality, aneurysm rupture risk, and life expectancy must be considered. This study investigates the outcomes of octogenarians that declined elective intervention for above-threshold AAA. This is the first study we are aware of investigating this patient group; historically, conservatively managed patients have been considered together. The results suggest that for octogenarians the benefit of elective EVAR is marginal, mostly due to high incidence of non-aneurysm-related mortality. This informs shared decision making for octogenarians.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028261471727","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:24:13Z","timestamp":1785389053000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes in Octogenarians Offered EVAR and Electing for Conservative Management: A Retrospective Cohort Study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5456-7233","authenticated-orcid":false,"given":"Sebastian","family":"Vaughan-Burleigh","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, Somerset NHS Foundation Trust, Taunton UK"},{"name":"Department of Vascular Surgery, Oxford University Hospitals NHS Foundation Trust, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angus","family":"Mitchell","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Somerset NHS Foundation Trust, Taunton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Wijaya","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Somerset NHS Foundation Trust, Taunton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Massey","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Somerset NHS Foundation Trust, Taunton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Coulston","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, Somerset NHS Foundation Trust, Taunton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.10430"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2011.07.011"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/15385744221149911"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/15266028241283669"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12216837"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2021.07.125"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-196610000-00014"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198910123211504"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02001003"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2168.1998.00947.x"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1067\/mva.2001.112800"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1067\/mva.2002.122889"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.287.22.2968"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/145749690209100407"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1067\/mva.2003.119"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/s1078-5884(03)00083-2"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-1433.2004.03211.x"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0911056"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2011.04.022"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2012.12.019"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2012.11.001"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2016.05.008"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2017.07.023"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/1708538118807075"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.23736\/S0021-9509.20.11377-6"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2022.09.012"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1186\/1751-0473-3-17"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v042.i07"},{"key":"e_1_3_3_30_2","doi-asserted-by":"crossref","unstructured":"Rosenbaum PR. 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