Patterson B O, Holt P J E, Hinchliffe R, Loftus I M, Thompson M M
St George's Vascular Institute, St James Wing, St George's Hospital, London SW17 0QT, UK.
Eur J Vasc Endovasc Surg. 2008 Dec;36(6):637-45. doi: 10.1016/j.ejvs.2008.08.016. Epub 2008 Oct 14.
To examine and compare existing pre-operative risk prediction methods for elective abdominal aortic aneurysm (AAA) repair.
Systematic review.
Medline, EMBASE and the Cochrane library were searched for articles that related to risk prediction models used for elective AAA repair.
680 abstracts were reviewed and after exclusions 28 articles encompassing 10 risk models were identified. The most frequently studied of these were the Glasgow Aneurysm Score (GAS), the Physiological and Operative Severity Score for enUmeration of Mortality (POSSUM) predictor equation and the Vascular Biochemistry and Haematology Outcome Model (VBHOM). All models had strengths and weaknesses and some had unique features which were identified and discussed.
The GAS appeared to be the most useful and consistently validated score at present for open repair. Other systems were either not validated fully or were not consistently accurate. Some had significant drawbacks which appeared to severely limit their clinical application. Recent work has shown that no scores consistently predicted the risk associated with endovascular aneurysm repair (EVAR). Pre-operative risk stratification is a vital component of modern surgical practice, and we propose the need for a comprehensive new risk scoring method for AAA repair incorporating anatomical and physiological data.
研究并比较现有的择期腹主动脉瘤（AAA）修复术前风险预测方法。
系统评价。
检索Medline、EMBASE和Cochrane图书馆，查找与用于择期AAA修复的风险预测模型相关的文章。
共检索680篇摘要，排除后确定了28篇文章，包含10种风险模型。其中研究最频繁的是格拉斯哥动脉瘤评分（GAS）、用于死亡率计数的生理和手术严重程度评分（POSSUM）预测方程以及血管生物化学和血液学结果模型（VBHOM）。所有模型都有优缺点，一些模型具有独特特征，已被识别并讨论。
目前，GAS似乎是开放修复中最有用且经过一致验证的评分。其他系统要么未得到充分验证，要么准确性不一致。一些系统存在严重缺陷，似乎严重限制了它们的临床应用。最近的研究表明，没有评分能够始终如一地预测与血管内动脉瘤修复（EVAR）相关的风险。术前风险分层是现代外科实践的重要组成部分，我们建议需要一种综合的新风险评分方法，用于AAA修复，纳入解剖学和生理学数据。
