Division of Vascular Surgery, The DeWitt Daughtry Family Department of Surgery, Leonard M. Miller School of Medicine, University of Miami Jackson Memorial Medical Center, Miami, FL, USA.
J Vasc Surg. 2010 Nov;52(5):1140-6. doi: 10.1016/j.jvs.2010.06.076.
Advanced age is a significant risk factor that has traditionally steered patients away from open aneurysm repair and toward expectant management. Today, however, the reduced morbidity and mortality of aortic stent grafting has created a new opportunity for aneurysm repair in patients previously considered too high a risk for open surgery. Here we report our experience with endovascular aneurysm repair (EVAR) in nonagenarians.
Retrospective chart review identified all patients>90-years-old undergoing EVAR over a 9-year period at our institution. Collected data included preoperative comorbidities, perioperative complications, endoleaks, reinterventions, and long-term survival.
24 patients underwent EVAR. The mean age was 91.5 years (range 90-94) among 15 (63%) males and 9 (37%) females. Mean abdominal aortic aneurysm diameter was 6.3±1.1 cm. Eight patients (33%) were symptomatic (pain or tenderness). There were no ruptures. Fourteen patients (58%) had general anesthesia while 10 (42%) had local or regional anesthesia. Mean postoperative length of stay was 3.2±2.4 days (2.8±1.9 days for asymptomatic vs 4.1±3.2 days for symptomatic, P=.29). There was one perioperative mortality (4.2%). There were two local groin seromas (8.3%) and six systemic complications (25%). One patient required reintervention for endoleak (4.2%). There were no aneurysm related deaths beyond the 30-day postoperative period. Mean survival beyond 30 days was 29.7±18.0 months for patients expiring during follow-up. Cumulative estimated 12, 24, and 36-month survival rates were 83%, 64%, and 50%, respectively. Linear regression analysis demonstrated an inverse relationship between the number of preoperative comorbidities and postoperative survival in our cohort (R2=0.701), with significantly decreased survival noted for patients presenting with >5 comorbidities. Those still alive in follow-up have a mean survival of 36.1±16.0 months.
This is the largest reported EVAR series in nonagenarians. Despite their advanced age, these patients benefit from EVAR with low morbidity, low mortality, and mean survival exceeding 2.4 years. Survival appears best in those patients with ≤5 comorbidities. With or without symptoms, patients over the age of 90 should be considered for EVAR.
高龄是一个重要的风险因素，传统上使患者远离开放型动脉瘤修复，转而采取期待治疗。然而，今天主动脉支架移植术的发病率和死亡率降低，为以前被认为开放手术风险过高的患者提供了新的动脉瘤修复机会。在此，我们报告了我们在 90 岁以上患者中进行血管内动脉瘤修复（EVAR）的经验。
回顾性图表审查确定了 9 年来我院所有接受 EVAR 治疗的>90 岁患者。收集的数据包括术前合并症、围手术期并发症、内漏、再次干预和长期生存。
24 例患者接受了 EVAR。15 例（63%）男性和 9 例（37%）女性的平均年龄为 91.5 岁（范围 90-94 岁）。平均腹主动脉瘤直径为 6.3±1.1cm。8 例（33%）患者有症状（疼痛或压痛）。没有破裂。14 例（58%）患者接受全身麻醉，10 例（42%）患者接受局部或区域麻醉。平均术后住院时间为 3.2±2.4 天（无症状者为 2.8±1.9 天，有症状者为 4.1±3.2 天，P=.29）。有 1 例围手术期死亡（4.2%）。有 2 例局部腹股沟血清肿（8.3%）和 6 例全身并发症（25%）。1 例患者因内漏需要再次干预（4.2%）。在术后 30 天内没有与动脉瘤相关的死亡。在随访期间死亡的患者，术后 30 天以上的平均生存率为 29.7±18.0 个月。累计估计 12、24 和 36 个月的生存率分别为 83%、64%和 50%。线性回归分析显示，我们队列中术前合并症数量与术后生存呈反比关系（R2=0.701），有>5 种合并症的患者生存率显著降低。在随访中仍存活的患者的平均生存时间为 36.1±16.0 个月。
这是报道的最大的 90 岁以上患者 EVAR 系列。尽管他们年龄较大，但这些患者受益于 EVAR，发病率低，死亡率低，平均生存时间超过 2.4 年。在合并症≤5 种的患者中生存情况最好。有症状或无症状的 90 岁以上患者均应考虑进行 EVAR。
