Compton Christopher N, Dillavou Ellen D, Sheehan Maureen K, Rhee Robert Y, Makaroun Michel S
Division of Vascular Surgery, University of Pittsburgh Medical Center, PA 15213, USA.
J Vasc Surg. 2005 Oct;42(4):650-3. doi: 10.1016/j.jvs.2005.03.066.
The life expectancy of patients with oxygen-dependent chronic obstructive pulmonary disease (COPD) is significantly reduced, but the risk of any intervention is considered prohibitive. However, severe COPD may increase the risk of abdominal aortic aneurysm (AAA) rupture. We reviewed our experience with AAA repair in oxygen-dependent patients to determine whether operative risk and expected long-term survival justify surgical intervention.
A retrospective review of 44 consecutive patients with oxygen-dependent COPD undergoing AAA repair over an 8-year period was performed. Information was recorded for survival, length of follow-up, patient age, medical comorbidities, pulmonary function tests, and operative approach. Survival data were analyzed by Kaplan-Meier curves and compared with published cohorts of oxygen-dependent patients and the natural history of untreated aneurysms.
Twenty-four patients underwent endovascular aneurysm repair (EVAR), and 20 underwent open procedures (14 retroperitoneal and 6 transabdominal). The mean AAA diameter was 6.1 cm (range, 5-9.5 cm). The mean age was 71.4 years, and 82% of patients were male. Operative mortality was 0%. The mean length of stay was 11.2 days for open procedures and 4.3 days for EVAR (significantly longer than that for standard-risk patients). The mean survival time was 37.9 months (range, 2-91 months). Preoperative medical comorbidities, type of repair, and pulmonary function tests were not predictive of survival. Postoperative morbidity was significantly higher with open repair. Long term survival was comparable to historical series of the natural history of O2 dependent patients without AAA but better than untreated 6 cm AAA cohorts. At 42 months, almost 50% of patients in our study group were still alive, compared to 20% survival at 34 months for those with untreated 6 cm AAAs.
It is reasonable to continue to offer AAA repair to home oxygen-dependent COPD patients who are ambulatory and medically optimized and who are without untreated coronary artery disease. Although EVAR may be the most suitable treatment for oxygen-dependent COPD patients, our results show that even open repair may be safely performed in this population, with acceptable results.
依赖氧气的慢性阻塞性肺疾病（COPD）患者的预期寿命显著缩短，但任何干预措施的风险都被认为过高。然而，重度COPD可能会增加腹主动脉瘤（AAA）破裂的风险。我们回顾了我们在依赖氧气的患者中进行AAA修复的经验，以确定手术风险和预期的长期生存率是否足以证明手术干预的合理性。
对8年间连续44例依赖氧气的COPD患者进行AAA修复的情况进行了回顾性研究。记录了生存情况、随访时间、患者年龄、合并症、肺功能测试和手术方式等信息。通过Kaplan-Meier曲线分析生存数据，并与已发表的依赖氧气患者队列以及未治疗动脉瘤的自然病史进行比较。
24例患者接受了血管内动脉瘤修复术（EVAR），20例接受了开放手术（14例经腹膜后，6例经腹）。AAA的平均直径为6.1 cm（范围5 - 9.5 cm）。平均年龄为71.4岁，82%的患者为男性。手术死亡率为0%。开放手术的平均住院时间为11.2天，EVAR为4.3天（明显长于标准风险患者）。平均生存时间为37.9个月（范围2 - 91个月）。术前合并症、修复类型和肺功能测试均不能预测生存情况。开放修复术后的发病率明显更高。长期生存率与无AAA的依赖氧气患者自然病史的历史系列相当，但优于未治疗的6 cm AAA队列。在42个月时，我们研究组中近50%的患者仍存活，而未治疗的6 cm AAA患者在34个月时的生存率为20%。
对于能够走动、病情得到优化且无未治疗冠状动脉疾病的依赖家庭氧气的COPD患者，继续提供AAA修复是合理的。虽然EVAR可能是依赖氧气的COPD患者最合适的治疗方法，但我们的结果表明，即使是开放修复在该人群中也可以安全进行，且结果可接受。
