Division of Vascular and Interventional Radiology, Baptist Cardiac and Vascular Institute, Miami, FL 33176, USA.
J Vasc Surg. 2011 Dec;54(6):1605-13. doi: 10.1016/j.jvs.2011.06.096. Epub 2011 Sep 9.
The purpose of this report was to present short and midterm results of endovascular aortic aneurysm repair (EVAR) of infrarenal aortic aneurysms in octogenarians and nonagenarians.
Between March 1994 and March 2011, elective EVAR was performed in 967 patients in our institution. This includes 279 patients older than 80 years at the time of the procedure (octogenarians: n = 252, nonagenarians: n = 27). Mean follow-up was 48.4 ± 34.5 months. A retrospective analysis was performed. Survival was calculated using Kaplan-Meier analysis and a survival comparison to patients who underwent EVAR <80 years old (n = 688) was performed. Cox hazard regression analysis was used to assess parameters that influence survival.
Technical success was 96% in octogenarians and 85% in nonagenarians. Technical failure in 15 of 279 patients includes primary type I endoleak (n = 6), procedure abortion due to inability to pass the iliac vessels (n = 6), and emergency conversion (n = 3). Thirty-day mortality was significantly higher for patients >80 years old (2.8% vs 1.0%; P = .044). Morbidity rates were 11.5% for octogenarians and 7.4% for nonagenarians with predominately cardiopulmonary complications. High-risk patients >80 years old showed a comparable perioperative mortality rate to low-/medium-risk patients >80 years old (2.9% vs 2.5%;P = .717), but a significantly higher complication rate (22.5% vs 9.2%; P = .0275) and reduced midterm survival with 1-, 3-, and 5-year survival rates of 79% ± SE 7%, 55% ± SE 8%, and 38% ± SE 9% (log-rank test P = .03). In high-risk patients age >80 years old, their age did not influence 30-day mortality (2.5% vs 2.7%; P = .978) and midterm survival. Survival in octogenarians at 1, 3, and 5 years was 87.9 ± SE 2.1%, 70.9 ± SE 3.0%, and 55.6% ± SE 3.5%, respectively. Survival in nonagenarians at 1 and 3 years was 96.3% ± SE 4% and 60.6% ± SE 10.4%. Higher cardiac (hazard ratio [HR], 1.22; P = .038) and renal risk scores (HR, 1.59; P = .0016), chronic obstructive pulmonary disease (HR, 1.56; P = .032), and anemia (HR, 2.1; P < .001) influenced midterm survival.
EVAR in octogenarians and nonagenarians is associated with a significantly higher but still low perioperative mortality compared to younger patients. Midterm survival in octogenarians and nonagenarians, although significantly lower than in younger patients, is still acceptable, indicating that age >80 years should not be an exclusion criteria for EVAR. Even high-risk patients >80 years can be treated safely with a low perioperative mortality and comparable midterm outcome to younger high-risk patients.
本报告旨在介绍高龄（80 岁及以上）和超高龄（90 岁及以上）患者接受腹主动脉瘤腔内修复术（EVAR）的短期和中期结果。
1994 年 3 月至 2011 年 3 月期间，我院对 967 例患者进行了择期 EVAR，其中 279 例患者在手术时年龄超过 80 岁（80 岁以上：n=252，90 岁以上：n=27）。平均随访时间为 48.4±34.5 个月。进行了回顾性分析。使用 Kaplan-Meier 分析计算生存率，并与接受 EVAR 治疗且年龄<80 岁的患者（n=688）进行生存比较。使用 Cox 风险回归分析评估影响生存的参数。
80 岁以上患者的技术成功率为 96%，90 岁以上患者的技术成功率为 85%。279 例患者中有 15 例（6 例原发性 I 型内漏、6 例因无法通过髂血管而中止手术、3 例紧急转为开放手术）发生技术失败。80 岁以上患者的 30 天死亡率明显高于年龄<80 岁的患者（2.8%比 1.0%；P=.044）。80 岁以上患者的并发症发生率为 11.5%，90 岁以上患者的并发症发生率为 7.4%，主要为心肺并发症。高风险（80 岁以上）患者的围手术期死亡率与低/中风险（80 岁以上）患者相似（2.9%比 2.5%；P=.717），但并发症发生率明显更高（22.5%比 9.2%；P=.0275），中期生存率较低，1、3 和 5 年生存率分别为 79%±SE7%、55%±SE8%和 38%±SE9%（对数秩检验 P=.03）。在高风险（80 岁以上）患者中，年龄对 30 天死亡率（2.5%比 2.7%；P=.978）和中期生存率无影响。80 岁以上患者的 1、3 和 5 年生存率分别为 87.9%±SE2.1%、70.9%±SE3.0%和 55.6%±SE3.5%。90 岁以上患者的 1 年和 3 年生存率分别为 96.3%±SE4%和 60.6%±SE10.4%。较高的心脏（风险比[HR]，1.22；P=.038）和肾脏风险评分（HR，1.59；P=.0016）、慢性阻塞性肺疾病（HR，1.56；P=.032）和贫血（HR，2.1；P<.001）影响中期生存率。
与年轻患者相比，80 岁及以上和 90 岁及以上患者接受 EVAR 治疗的围手术期死亡率虽有所升高，但仍处于较低水平。80 岁及以上和 90 岁及以上患者的中期生存率虽然明显低于年轻患者，但仍可接受，表明年龄>80 岁不应作为 EVAR 的排除标准。即使是高风险（80 岁以上）患者，也可以安全地进行治疗，其围手术期死亡率较低，中期结果与年轻高风险患者相当。
