Service de chirurgie cardio vasculaire, CHU Le Bocage, Dijon, France.
Eur J Vasc Endovasc Surg. 2010 Apr;39(4):403-9. doi: 10.1016/j.ejvs.2009.12.009. Epub 2010 Jan 8.
The concept of high-risk patients suggests that such patients will experience a higher rate of postoperative complications and worse short- and long-term outcomes, and should therefore benefit from the use of endovascular techniques for aortic abdominal aneurysm (AAA) repair. The primary goal of this study was to assess the relevance of the different high-risk criteria, defined by the French health agency Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS) in a single-centre continuous series. Secondary goals were to retrospectively compare the incidence of postoperative complications and short- and long-term survival in three groups of patients.
Between January 1999 and December 2006, details of all the patients undergoing elective surgery for AAA in our hospital were recorded into a prospective registry (n=626). Three groups were considered according to the level of risk and type of repair defined by the AFSSAPS: endovascular aortic aneurysm repair (EVAR) high-risk (HR) (at least one high-risk factor and EVAR, n=138), open HR (at least one high-risk factor and open repair, n=134) and open low-risk (LR) (no high-risk factors and open repair, n=344). None of the low-risk patients were treated using an endovascular approach. The demographics, preoperative risk factors, intra-, postoperative data and short- and long-term survival were compared between the groups. Interrelations among the set of high-risk criteria for mortality were calculated using multiple correspondence analysis (MCA).
The distribution of high-risk criteria was similar in both high-risk groups, except for age, heart failure and hostile abdomen, which were significantly more frequent in EVAR HR. Operation time, blood loss and length of stay in an intensive care unit and hospital were significantly lower in the EVAR HR group. The 30-day mortality and survival rates at 5 years were 5.4 and 59.4% for EVAR HR, 3.7 and 70.4% for open HR and 2.3 and 83.7% for open LR, respectively, with no significant difference between the three groups for the mortality, but a significant higher survival at 5 years for the open LR versus both high-risk groups.
The high-risk AFSSAPS criteria were not predictive of postoperative mortality and should not be used to determine the choice of treatment technique. Other criteria therefore need to be established to determine whether open or EVAR repair should be used.
高危患者的概念表明，此类患者术后并发症发生率和短期及长期预后更差，因此应受益于血管内技术治疗腹主动脉瘤（AAA）。本研究的主要目的是评估法国卫生机构法国保健产品安全局（AFSSAPS）在单一中心连续系列中定义的不同高危标准的相关性。次要目标是回顾性比较三组患者术后并发症和短期及长期生存率的发生率。
1999 年 1 月至 2006 年 12 月，我院所有择期手术治疗 AAA 的患者的详细信息均记录在一个前瞻性登记处（n=626）中。根据 AFSSAPS 定义的风险水平和修复类型，将患者分为三组：血管内主动脉瘤修复（EVAR）高危（HR）（至少存在一个高危因素和 EVAR，n=138）、开放 HR（至少存在一个高危因素和开放修复，n=134）和开放低危（LR）（无高危因素和开放修复，n=344）。没有任何低危患者采用血管内方法治疗。比较了三组患者的人口统计学、术前危险因素、术中、术后数据以及短期和长期生存率。使用多元对应分析（MCA）计算死亡率相关高危标准的相互关系。
两组高危患者的高危标准分布相似，除了年龄、心力衰竭和敌对腹部，EVAR HR 中更为常见。EVAR HR 组的手术时间、出血量和 ICU 及医院住院时间明显较低。EVAR HR 组的 30 天死亡率和 5 年生存率分别为 5.4%和 59.4%，开放 HR 组分别为 3.7%和 70.4%，开放 LR 组分别为 2.3%和 83.7%，三组间死亡率无显著性差异，但开放 LR 组的 5 年生存率明显高于两组高危组。
AFSSAPS 的高危标准不能预测术后死亡率，不应用于确定治疗技术的选择。因此，需要建立其他标准来确定是采用开放或 EVAR 修复。
