Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
J Vasc Surg. 2011 Aug;54(2):287-94. doi: 10.1016/j.jvs.2010.12.046. Epub 2011 Mar 2.
Compared with open repair of abdominal aortic aneurysms (AAA), endovascular repair (EVAR) is associated with decreased perioperative morbidity and mortality in a standard patient population. This study sought to determine if the advantage of EVAR extends to patients aged ≥90 years.
This was a retrospective review from a prospectively maintained computerized database. Of the 322 patients aged ≥80 treated with EVAR from January 1997 to November 2007, 24 (1.9%) were aged ≥90. Mean age was 91.5 ± 1.5 years (range, 90-95 years), and 83.3% were men. Mean aneurysm size was 6.8 cm (range, 5.2-8.7 cm).
Mean procedural blood loss was 490 mL (range, 100-4150 mL), and 20.8% required an intraoperative transfusion. Mean postoperative length of stay was 6.0 days, (median, 4 days; mode, 1 day; range, 1-42 days), with 33.3% of patients discharged on the first postoperative day. Amongst the 24 patients, there were 6 (25.0%) perioperative major adverse events, and 2 patients died, for a perioperative mortality rate of 8.3%. Mean follow-up was 20.5 months (range, 1-49 months). Overall, three patients (12.5%) required a secondary intervention, comprising thrombectomy, angioplasty, and proximal cuff extension. No patients required conversion to open repair. Two patients (8.3%) died of AAA rupture at 507 and 1254 days. Freedom from all-cause mortality was 83.3% at 1 year and 19.3% at 5 years. Freedom from aneurysm-related mortality was 87.5% at 1 year and 73.2% at 5 years. Endoleak occurred in five patients (20.8%), with three type I and two of indeterminate type; of these, two patients with type I endoleak underwent secondary intervention at 153 and 489 days after EVAR, of which one case was successful.
Our study supports that EVAR in nonagenarians is associated with acceptable procedural success and perioperative morbidity and mortality. The medium-term results suggest that EVAR may be of limited benefit in very carefully selected patients who are aged ≥90 years.
与开放修复腹主动脉瘤（AAA）相比，血管内修复（EVAR）可降低标准患者人群的围手术期发病率和死亡率。本研究旨在确定 EVAR 的优势是否扩展到 90 岁以上的患者。
这是一项回顾性研究，来自一个前瞻性维护的计算机化数据库。1997 年 1 月至 2007 年 11 月期间，对 322 名年龄≥80 岁接受 EVAR 治疗的患者进行了回顾性分析，其中 24 名（1.9%）年龄≥90 岁。平均年龄为 91.5±1.5 岁（范围，90-95 岁），83.3%为男性。平均动脉瘤大小为 6.8cm（范围，5.2-8.7cm）。
平均手术失血量为 490ml（范围，100-4150ml），20.8%需要术中输血。平均术后住院时间为 6.0 天（中位数，4 天；模式，1 天；范围，1-42 天），33.3%的患者在术后第一天出院。在 24 名患者中，有 6 名（25.0%）发生围手术期重大不良事件，2 名患者死亡，围手术期死亡率为 8.3%。平均随访时间为 20.5 个月（范围，1-49 个月）。总的来说，有 3 名患者（12.5%）需要进行二次介入治疗，包括血栓切除术、血管成形术和近端袖口延伸。没有患者需要转为开放修复。有 2 名患者（8.3%）在 507 天和 1254 天因 AAA 破裂死亡。1 年时的全因死亡率为 83.3%，5 年时为 19.3%。1 年时的动脉瘤相关死亡率为 87.5%，5 年时为 73.2%。有 5 名患者（20.8%）发生内漏，其中 3 型 I 型和 2 型不确定型；其中，2 型 I 型内漏患者分别于 EVAR 后 153 天和 489 天进行了二次介入治疗，其中 1 例成功。
我们的研究支持，血管内修复在 90 岁以上的非老年人中与可接受的手术成功率和围手术期发病率和死亡率相关。中期结果表明，EVAR 可能对非常谨慎选择的年龄≥90 岁的患者的获益有限。
