Department of Vascular and Endovascular Surgery, Universidade Positivo, Curitiba, Paraná, Brazil.
J Endovasc Ther. 2010 Feb;17(1):89-94. doi: 10.1583/09-2872.1.
To analyze the initial and long-term results of endovascular aneurysm repair (EVAR) in high-surgical-risk patients (i.e., age > or =80 years, serum creatinine level > or =3 mg/dL, severe pulmonary dysfunction, severe cardiac dysfunction).
From April 2002 to June 2009, 50 consecutive high-surgical-risk patients (42 men; mean age 74.0+/-8.7, range 54-91) with an abdominal aortic aneurysm (AAA; mean diameter 64.8 mm) who were treated electively using a bifurcated aortic endograft (32 Excluder, 18 Zenith) were entered in a prospective registry. Thirty-five (70%) patients were classified ASA III and 15 (30%) were ASA IV. High-risk status was corroborated using the Customized Probability Index (CPI). Primary endpoints were operative mortality and long-term survival; secondary endpoints were the frequency of reintervention, evolution of the aneurysm sac, and rates of primary and secondary patency and rupture.
The mean CPI score was 11.04+/-6.3. Operative mortality was 2% (1/50). There were 4 endoleaks, 1 case of endotension, and 1 endograft limb occlusion. Two patients required reintervention during the mean follow-up of 35.6 months. Survival at 3 years was 94%. Primary and secondary patency rates at 3 years were 98% and 100%, respectively. There were no ruptures.
Initial and long-term results with endovascular treatment of AAA in high-surgical-risk patients were satisfactory and appear to justify this approach in this patient population.
分析高手术风险患者（即年龄≥80 岁、血清肌酐水平≥3mg/dL、严重肺功能障碍、严重心功能障碍）血管内动脉瘤修复（EVAR）的初始和长期结果。
从 2002 年 4 月至 2009 年 6 月，50 例连续的高手术风险患者（42 例男性；平均年龄 74.0±8.7 岁，范围 54-91 岁）因腹主动脉瘤（AAA；平均直径 64.8mm）接受了分叉式主动脉内移植物（32 个 Excluder，18 个 Zenith）的选择性治疗，这些患者被纳入了一项前瞻性注册研究。35 例（70%）患者被分类为 ASA III，15 例（30%）为 ASA IV。高风险状态通过定制概率指数（CPI）得到证实。主要终点是手术死亡率和长期生存率；次要终点是再干预的频率、动脉瘤囊的演变以及一期和二期通畅率和破裂率。
平均 CPI 评分为 11.04±6.3。手术死亡率为 2%（1/50）。有 4 例内漏，1 例内张力，1 例移植物分支闭塞。在平均 35.6 个月的随访中，有 2 例患者需要再次干预。3 年生存率为 94%。3 年的一期和二期通畅率分别为 98%和 100%。没有破裂。
在高手术风险患者中，血管内治疗 AAA 的初始和长期结果令人满意，这似乎证明了在该患者人群中采用这种方法是合理的。
