Conway K P, Byrne J, Townsend M, Lane I F
Cardiff Vascular Unit, University Hospital of Wales, Heath Park, UK.
J Vasc Surg. 2001 Apr;33(4):752-7. doi: 10.1067/mva.2001.112800.
The United Kingdom Small Aneurysm study has demonstrated the low risk of rupture in aneurysms less than 5.5 cm in diameter. With the advent of endoluminal techniques, patients considered unfit to undergo laparotomy are now considered for endovascular repair. However, the natural history of aneurysms larger than 5.5 cm remains uncertain, especially when severe comorbidity is present. In our center, we prospectively maintain records of all patients for whom elective aneurysm surgery was refused. This study documented the outcome of all patients referred with abdominal aortic aneurysms (AAAs) larger than 5.5 cm in diameter who were turned down for elective open repair and determined the cause of death and risk of rupture in all patients.
Details of all patients with AAAs from January 5, 1989, to January 5, 1999, were recorded, and demographic details on all patients with AAAs larger than 5.5 cm were collected. Copies of death certificates were obtained from the Office of National Statistics, local in-hospital patient records, and general practitioner records. Results of postmortem examinations were also obtained. Aneurysms were stratified according to their size at presentation (5.5-5.9 cm, 6.0-7.0 cm, and > 7.0 cm), and the reasons no intervention was made were documented.
A total of 106 patients were turned down for elective aneurysm surgery in the 10-year period (10.6 per year). The mean age of the patients was 78.4 years (SD, 7.4), and 70 were men and 36 were women. At the end of the study, 76 patients (71.7%) had died. Overall, the 3-year survival rate was 17%. Patients with AAAs larger than 7.0 cm lived a median of 9 months. A ruptured aneurysm was certified as a cause of death in 36% of the patients with an AAA of 5.5 to 5.9 cm, in 50% of the patients with an AAA of 6 to 7.0 cm, and 55% of the patients with an AAA larger than 7.0 cm. Reasons given for not intervening were patient refusal (31 cases), the patient being "unfit for surgery" (18 cases), the "advanced age" of the patient (18 cases), cardiac disease (9 cases), cancer (9 cases), respiratory disease (6 cases), and other (15 cases).
Although we recognize the problems with death certification, we found that rupture was a significant cause of death in patients with an untreated AAA that was larger than 5.5 cm. Although little difference in outcome was observed in aneurysms in the 5.5 to 7.0 cm size range, patients with an AAA that was larger than 7.0 cm seemed to have a much poorer prognosis.
英国小型动脉瘤研究表明，直径小于5.5厘米的动脉瘤破裂风险较低。随着腔内技术的出现，现在认为不适合接受剖腹手术的患者可考虑进行血管内修复。然而，直径大于5.5厘米的动脉瘤的自然病史仍不确定，尤其是在存在严重合并症的情况下。在我们中心，我们前瞻性地记录了所有拒绝接受择期动脉瘤手术的患者的情况。本研究记录了所有转诊来的直径大于5.5厘米的腹主动脉瘤（AAA）患者拒绝接受择期开放修复后的结局，并确定了所有患者的死亡原因和破裂风险。
记录了1989年1月5日至1999年1月5日期间所有AAA患者的详细信息，并收集了所有直径大于5.5厘米的AAA患者的人口统计学详细信息。从国家统计局办公室、当地医院患者记录和全科医生记录中获取死亡证明副本。还获得了尸检结果。根据动脉瘤出现时的大小（5.5 - 5.9厘米、6.0 - 7.0厘米和> 7.0厘米）进行分层，并记录未进行干预的原因。
在这10年期间，共有106例患者拒绝接受择期动脉瘤手术（每年10.6例）。患者的平均年龄为78.4岁（标准差7.4），男性70例，女性36例。在研究结束时，76例患者（71.7%）死亡。总体而言，3年生存率为17%。直径大于7.0厘米的AAA患者的中位生存期为9个月。在直径为5.5至5.9厘米的AAA患者中，36%的患者死亡原因被确认为动脉瘤破裂；在直径为6至7.0厘米的AAA患者中，这一比例为50%；在直径大于7.0厘米的AAA患者中，这一比例为55%。未进行干预的原因包括患者拒绝（31例）、患者“不适合手术”（18例）、患者“高龄”（18例）、心脏病（9例）、癌症（9例）、呼吸系统疾病（6例）和其他（15例）。
尽管我们认识到死亡证明存在问题，但我们发现破裂是未治疗的直径大于5.5厘米的AAA患者的一个重要死亡原因。尽管在5.5至7.0厘米大小范围内的动脉瘤在结局上观察到的差异不大，但直径大于7.0厘米的AAA患者的预后似乎要差得多。
