Zannetti S, De Rango P, Parlani G, Verzini F, Maselli A, Cao P
Unit of Vascular Surgery, Policlinico Monteluce, Perugia, Italy.
Eur J Vasc Endovasc Surg. 2001 Apr;21(4):334-8. doi: 10.1053/ejvs.2001.1345.
to evaluate the role of endovascular repair (ER) of abdominal aortic aneurysm (AAA) repair in American Society for Anaesthesiology [ASA] class IV patients.
between April 1997 and March 2000, 266 consecutive patients underwent ER for AAA. There were 26 patients (10%) with ASA grade IV. The remaining 240 patients, ASA grade between I and III (ASA<IV group), were compared with the ASA IV group. Mean follow-up was 11.6 months (range 1-32 months). Increase in AAA diameter after ER or persisting graft-related endoleak were defined as failure of AAA exclusion. Regression analysis was performed to test the effect of five confounding variables on failure of AAA exclusion and perioperative mortality.
patients in the ASA IV group were significantly older than patients in ASA <IV group (mean age: 74 years vs 70 years p=0.005). AAA were larger (mean diameter: 56 mm vs 50 mm p =0.002) and more extensive (class E of EUROSTAR classification: 27% vs 5.8% p =0.002). There were two perioperative deaths in the ASA IV group and one in the ASA<IV group (8% vs 0.4%; RR 19; 95% CI 1.8-202 p=0.01). Major perioperative morbidity occurred in 8% of patients in the ASA IV group and in 3.3% in the ASA<IV group (n.s.). There were no conversions to open repair in the ASA IV group while six were performed in the ASA<IV group (n.s.). Length of hospitalisation was significantly longer for patients in the ASA IV group: 7.8 days vs 3.2 days (p =0.001). Operative times and blood loss were similar. Failure of AAA exclusion occurred in two patients (8%) in the ASA IV group and in four patients (1.6%) in the ASA<IV group (n.s.). On life table analysis, survival rates at 26 months were 76% in the ASA IV group and 89% in the ASA<IV group (p =0.004). Five variables were examined by regression analysis and no independent predictors of failure of AAA exclusion and operative mortality were found.
ER in ASA IV patients is feasible and effective with acceptable actuarial survival rates. However, the endovascular procedure in these patients is associated with higher major systemic morbidity, mortality, and prolonged hospitalisation rates.
评估腹主动脉瘤（AAA）血管腔内修复术（ER）在美国麻醉医师协会（ASA）IV级患者中的作用。
1997年4月至2000年3月期间，266例连续患者接受了AAA的ER治疗。其中26例（10%）为ASA IV级。其余240例患者，ASA分级在I至III级之间（ASA<IV组），与ASA IV组进行比较。平均随访时间为11.6个月（范围1 - 32个月）。ER术后AAA直径增加或持续存在与移植物相关的内漏被定义为AAA排除失败。进行回归分析以测试五个混杂变量对AAA排除失败和围手术期死亡率的影响。
ASA IV组患者显著比ASA<IV组患者年龄大（平均年龄：74岁对70岁，p = 0.005）。AAA更大（平均直径：56 mm对50 mm，p = 0.002）且范围更广（欧洲之星分类E级：27%对5.8%，p = 0.002）。ASA IV组有2例围手术期死亡，ASA<IV组有1例（8%对0.4%；相对危险度19；95%可信区间1.8 - 202，p = 0.01）。ASA IV组8%的患者发生了主要围手术期并发症，ASA<IV组为3.3%（无显著性差异）。ASA IV组没有转为开放修复的病例，而ASA<IV组有6例（无显著性差异）。ASA IV组患者的住院时间显著更长：7.8天对3.2天（p = 0.001）。手术时间和失血量相似。ASA IV组有2例患者（8%）发生AAA排除失败，ASA<IV组有4例患者（1.6%）（无显著性差异）。根据生命表分析，26个月时ASA IV组的生存率为76%，ASA<IV组为89%（p = 0.004）。通过回归分析检查了五个变量，未发现AAA排除失败和手术死亡率的独立预测因素。
ASA IV级患者的ER是可行且有效的，精算生存率可接受。然而，这些患者的血管腔内手术与更高的主要全身并发症、死亡率和延长的住院率相关。
