St George's Vascular Institute, St George's Hospital Healthcare NHS Trust, London SW17 0QT, UK.
Eur J Vasc Endovasc Surg. 2011 Sep;42(3):295-301. doi: 10.1016/j.ejvs.2011.04.022. Epub 2011 May 14.
The basic premise in managing patients with abdominal aortic aneurysms (AAA) must be to reduce overall mortality from the disease. Operative mortality is widely reported, but data on patients deemed unsuitable for repair are scarce. The purpose of the present study was to report the fate of patients referred with AAA, to define the proportion deemed unsuitable for surgery and to investigate the reasons for conservative treatment.
All patients who were referred to a regional vascular centre with large (>5.5 cm) infra-renal AAA between 1st January 2008 and 31st December 2009 were included. Patients were classified into two groups; those managed non-operatively, or those offered elective repair. Survival was reported by Kaplan-Meier analysis. Multivariate analysis investigated factors leading to non-operative management.
251 patients with a mean (s.d.) age of 75(8) years were assessed. Thirty-two (13%) patients were deemed unsuitable for repair, mostly because of medical co-morbidity (16/32). 219/251 (87%) patients underwent repair (25/251 (10%) open repair 194/251 (77%) EVAR) with 1/219 (0.5%) 30-day mortality. AAA repair was associated with significantly greater survival (p < 0.001, log-rank test) at 2 years. In multivariate analysis Glasgow Aneurysm Score, female gender and respiratory disease were significant predictors of the decision to treat patients conservatively (p < 0.001).
Most patients were suitable for surgical intervention with low perioperative mortality. Data on "turndown" rates should be routinely reported to quantify the denominator for operative success.
管理腹主动脉瘤（AAA）患者的基本前提必须是降低该疾病的总体死亡率。手术死亡率已被广泛报道，但关于不适合手术修复的患者的数据却很少。本研究的目的是报告患有 AAA 的患者的情况，确定被认为不适合手术的患者比例，并调查保守治疗的原因。
所有在 2008 年 1 月 1 日至 2009 年 12 月 31 日期间被转诊至区域性血管中心的大（>5.5 厘米）肾下 AAA 患者均被纳入本研究。患者被分为两组：非手术治疗组或择期手术修复组。采用 Kaplan-Meier 分析报告生存率。多变量分析调查了导致非手术治疗的因素。
评估了 251 例平均（标准差）年龄为 75（8）岁的患者。32 例（13%）患者被认为不适合手术修复，主要是由于合并症（16/32）。251 例患者中有 219 例（87%）接受了手术修复（25/251 例（10%）开放修复，194/251 例（77%）EVAR），其中 1/219 例（0.5%）在 30 天内死亡。AAA 修复与显著更高的生存相关（p < 0.001，对数秩检验），2 年生存率为 77%。在多变量分析中，格拉斯哥动脉瘤评分、女性性别和呼吸系统疾病是决定保守治疗患者的显著预测因素（p < 0.001）。
大多数患者适合手术干预，围手术期死亡率较低。“拒绝”率的数据应定期报告，以量化手术成功的分母。
