St. James Hospital, Dublin, Ireland.
Ir J Med Sci. 2012 Mar;181(1):73-6. doi: 10.1007/s11845-011-0779-0. Epub 2011 Oct 29.
The incidence of arterial disease increases with age. Increasing life expectancy in the western world will intensify demands on vascular surgeons with regard to increasing caseload, expanding patient selection criteria, and more complex and minimally-invasive treatment options. We analysed our arterial cases over the past 31 years (n = 6,144) and compared our methods of intervention and complication rates in the elderly population (>75) with the younger cohort, in order to determine whether age should influence our management strategies.
Data were collected prospectively on all arterial cases from 1978 to 2009. Methods of intervention and corresponding complication rates in the over and under 75-year-old cohorts were analyzed utilizing Fisher's exact test to calculate two-sided p values, relative risks and 95% confidence intervals.
Endovascular management has evolved to become the first line approach for all arterial cases (except carotid disease). Age was a significant risk factor for death and MI for the open procedures of AAA repair (p = 0.049 and p = 0.007, respectively), aorto-bifemoral reconstruction (p < 0.0001 and p = 0.006) and lower limb bypass (p = 0.01 and p < 0.001). For endovascular procedures, age did not impact on MI rate for EVAR (p = 0.78) or death rates for EVAR (p = 0.46), iliac angioplasty (p = 0.62) or lower limb angioplasty (p = 0.29).
A paradigm shift has occurred towards endovascular management of aortic, iliac and femoral arterial disease. Whilst patient age >75 significantly impacts on complication rates from index open vascular procedures, age does not impact upon complication rates of corresponding endovascular procedures. We, therefore, recommend an endovascular approach be adopted as first line for all patients, regardless of patient age.
动脉疾病的发病率随年龄增长而增加。在西方世界，预期寿命的延长将使血管外科医生面临更大的挑战，包括增加工作量、扩大患者选择标准以及采用更复杂和微创的治疗方法。我们分析了过去 31 年（1978 年至 2009 年）的动脉病例，并比较了 75 岁以上老年患者与年轻患者的干预方法和并发症发生率，以确定年龄是否会影响我们的治疗策略。
前瞻性收集了 1978 年至 2009 年所有动脉病例的数据。利用 Fisher 确切检验分析 75 岁以上和以下患者的介入方法和相应的并发症发生率，计算双侧 p 值、相对风险和 95%置信区间。
腔内治疗已成为所有动脉病例（颈动脉疾病除外）的一线治疗方法。年龄是 AAA 修复（p = 0.049 和 p = 0.007）、主动脉-股动脉重建（p < 0.0001 和 p = 0.006）和下肢旁路手术（p = 0.01 和 p < 0.001）开放手术的死亡和 MI 的显著危险因素。对于腔内手术，年龄并不影响 EVAR 的 MI 发生率（p = 0.78）或 EVAR 的死亡率（p = 0.46）、髂动脉成形术（p = 0.62）或下肢血管成形术（p = 0.29）。
主动脉、髂动脉和股动脉疾病的腔内治疗方法发生了转变。虽然 >75 岁的患者的开放血管手术的并发症发生率显著增加，但年龄并不影响相应的腔内手术的并发症发生率。因此，我们建议对所有患者采用腔内治疗作为一线治疗方法，无论患者年龄如何。
