Henebiens Margot, Vahl Anco, Koelemay Mark J W
Department of Surgery of Tergooiziekenhuizen, Hilversum, The Netherlands.
J Vasc Surg. 2008 Mar;47(3):676-81. doi: 10.1016/j.jvs.2007.09.004. Epub 2008 Jan 22.
Abdominal aortic aneurysm (AAA) is an age-related disease. In an aging population, the prevalence of AAA is likely to increase. Open AAA repair in patients aged >80 years is often not considered because of their advanced age as such or because of comorbidities. In addition, little is known about the natural history in such patients or survival after successful repair. We performed a systematic review of the literature to determine peri-operative and late survival after AAA repair in octogenarians
The Medline, Embase, and Cochrane databases were searched to identify all studies reporting on octogenarians undergoing AAA repair published between January 1966 and June 2006. Two independent observers assessed the methodologic quality of the included studies and the data extraction. Outcomes were rates of perioperative mortality, complications, and long-term survival after open or endovascular repair (EVAR). Summary estimates with 95% confidence interval (CI) were calculated using a random effects model.
Thirty-nine articles were included. The median aneurysm size was 6.7 cm in the conventional AAA repair group of 1534 patients. The perioperative mortality was 0% to 33%, with a pooled mortality of 7.5% (95% CI, 6.2% to 9.0%). The median 5-year survival rate for this group was 60% (range, 14% to 86%). In the 1045 patients treated with EVAR, the median aneurysm size was 5.9 cm. Their pooled perioperative mortality varied from 0% to 6%, with a pooled mortality of 4.6% (95% CI, 3.4 to 6.0%). We could not derive 5-year survival rates from articles describing endovascular repair of AAA.
The mortality rate after open or endovascular AAA repair in carefully selected octogenarians seems acceptable but is higher than the mortality rate in younger patients. Long-term survival rates were acceptable, but small sample size, selection, and publication bias must be taken into account. Finally, selection criteria for successful surgery with low mortality and morbidity rates cannot be derived from the literature.
腹主动脉瘤（AAA）是一种与年龄相关的疾病。在老龄化人群中，AAA的患病率可能会增加。由于年龄较大或存在合并症，80岁以上患者通常不考虑进行开放性AAA修复。此外，对于这类患者的自然病史或成功修复后的生存率知之甚少。我们对文献进行了系统综述，以确定八旬老人AAA修复术后的围手术期和远期生存率。
检索Medline、Embase和Cochrane数据库，以识别1966年1月至2006年6月期间发表的所有关于八旬老人接受AAA修复的研究。两名独立观察者评估纳入研究的方法学质量和数据提取情况。结局指标为开放性或血管腔内修复（EVAR）术后的围手术期死亡率、并发症发生率和长期生存率。使用随机效应模型计算95%置信区间（CI）的汇总估计值。
纳入39篇文章。在1534例患者的传统AAA修复组中，动脉瘤大小中位数为6.7 cm。围手术期死亡率为0%至33%，汇总死亡率为7.5%（95%CI，6.2%至9.0%）。该组的5年生存率中位数为60%（范围，14%至86%）。在接受EVAR治疗的1045例患者中，动脉瘤大小中位数为5.9 cm。他们的汇总围手术期死亡率从0%至6%不等，汇总死亡率为4.6%（95%CI，3.4至6.0%）。我们无法从描述AAA血管腔内修复的文章中得出5年生存率。
在经过精心挑选的八旬老人中，开放性或血管腔内AAA修复术后的死亡率似乎可以接受，但高于年轻患者。长期生存率是可以接受的，但必须考虑样本量小、选择偏倚和发表偏倚。最后，无法从文献中得出低死亡率和发病率的成功手术选择标准。
