Khashram Manar, Jenkins Julie S, Jenkins Jason, Kruger Allan J, Boyne Nicholas S, Foster Wallace J, Walker Philip J
Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia
Department of Vascular Surgery, Royal Brisbane and Women's Hospital, University of Queensland, Brisbane, Australia.
Vascular. 2016 Apr;24(2):115-25. doi: 10.1177/1708538115586682. Epub 2015 May 12.
Abdominal aortic aneurysms can be either treated by an open abdominal aortic aneurysm repair or an endovascular repair. Comparing clinical predictors of outcomes and those which influence survival rates in the long term is important in determining the choice of treatment offered and the decision-making process with patients.
To determine the influence of pre-existing clinical predictors and perioperative determinants on late survival of elective open abdominal aortic aneurysm repair and endovascular repair at a tertiary hospital.
Consecutive patients undergoing elective abdominal aortic aneurysm repair from 1990 to 2013 were included. Data were collected from a prospectively acquired database and death data were gathered from the Queensland state death registry. Pre-existing risks and perioperative factors were assessed independently. Kaplan-Meier and Cox regression modeling were performed.
During the study period, 1340 abdominal aortic aneurysms were repaired electively, of which 982 were open abdominal aortic aneurysm repair. The average age was 72.4 years old and 81.7% were males. The cumulative percentage survival rates for open abdominal aortic aneurysms repair at 5, 10, 15 and 20 years were 79, 49, 31 and 22, respectively. The corresponding 5-, 10- and 15-year survival rates for endovascular repair were not significantly different at 75, 49 and 33%, respectively (P = 0.75). Predictors of reduced survival were advanced age, American Society of Anaesthesiology scores, chronic obstructive pulmonary disease, renal impairment, bifurcated grafts, peripheral vascular disease and congestive heart failure.
Open repair offers a good long-term treatment option for patients with an abdominal aortic aneurysm and in our experience there is no significant difference in late survival between open abdominal aortic aneurysms repair and endovascular repair. Consideration of the factors identified in this study that predict reduced long-term survival for open abdominal aortic aneurysms repair and endovascular repair should be considered when deciding repair of abdominal aortic aneurysm.
腹主动脉瘤可通过开放性腹主动脉瘤修复术或血管腔内修复术进行治疗。比较两种治疗方式的临床预后预测因素以及长期生存率的影响因素，对于确定治疗方案的选择以及与患者共同进行决策过程至关重要。
确定三级医院中，术前临床预测因素和围手术期决定因素对择期开放性腹主动脉瘤修复术和血管腔内修复术远期生存的影响。
纳入1990年至2013年期间接受择期腹主动脉瘤修复术的连续患者。数据来自前瞻性获取的数据库，死亡数据则从昆士兰州死亡登记处收集。对术前风险和围手术期因素进行独立评估。采用Kaplan-Meier法和Cox回归模型进行分析。
在研究期间，共对1340例腹主动脉瘤进行了择期修复，其中982例接受了开放性腹主动脉瘤修复术。平均年龄为72.4岁，男性占81.7%。开放性腹主动脉瘤修复术在5年、10年、15年和20年的累积生存率分别为79%、49%、31%和22%。血管腔内修复术相应的5年、10年和15年生存率分别为75%、49%和33%，差异无统计学意义（P = 0.75）。生存率降低的预测因素包括高龄、美国麻醉医师协会评分、慢性阻塞性肺疾病、肾功能损害、分叉型移植物、外周血管疾病和充血性心力衰竭。
开放性修复为腹主动脉瘤患者提供了良好的长期治疗选择，根据我们的经验，开放性腹主动脉瘤修复术和血管腔内修复术的远期生存率无显著差异。在决定腹主动脉瘤修复方式时，应考虑本研究中确定的可预测开放性腹主动脉瘤修复术和血管腔内修复术长期生存率降低的因素。
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