Aortic pathologies, such as aneurysm and dissection, can be associated with significant short- and long-term morbidity and mortality. These processes generally increase in incidence with age, further complicating management of an already challenging entity. Our global population distribution also continues to shift older in general, as human longevity increases and birth rates decrease. The World Health Organization estimates that one in six people worldwide will be older than 60 years in 2030, and the number of people older than 80 years may triple during the same period [1]. With improved screening and imaging technology, as well as more options for intervention, population-level studies have unsurprisingly predicted a concomitant rise in the incidence of aortic disease and repair in older adults, particularly in disease with increased complexity [2,3].

Although open surgical repair remains a gold standard, the rapid evolution of endovascular therapy has provided new options for patients limited by frailty, severe cardiopulmonary disease, and other comorbidities that preclude consideration of major open surgery. Older adults, although heterogeneous in educational attainment, socioeconomic status, and medical comorbidity, represent, in general, a vulnerable population when considering advanced, high-risk interventions for aortic disease. There is, therefore, a need for thorough understanding of the specific issues germane to the geriatric population when deciding on appropriate management. We sought to catalog the current evidence base for complex aortic repair in the geriatric population, here defined as those 80 years or older, with intention to help guide clinical decision making as well as future research.