Bastos Gonçalves Frederico, Ultee Klaas H J, Hoeks Sanne E, Stolker Robert J, Verhagen Hence J M
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands; Department of Vascular Surgery, Hospital de Santa Marta, CHLC, NOVA Medical School, Lisbon, Portugal.
Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
J Vasc Surg. 2016 Mar;63(3):610-6. doi: 10.1016/j.jvs.2015.09.030. Epub 2015 Nov 6.
Life expectancy and causes of death after abdominal aortic aneurysm (AAA) repair are not well characterized. Population aging and improved secondary prevention may have modified the prognosis of these patients. We designed a retrospective cohort study to determine the vital prognosis, causes of death, and differences in outcome after intact and ruptured AAA.
All patients with AAA treated from 2003 to 2011 at a single university institution in The Netherlands were analyzed. Survival status was derived from civil registry data. Causes of death were obtained from death certificates. The primary end point was overall mortality. Secondary end points were cardiovascular, cancer-related, and AAA-related mortality. Predictors for perioperative and late survival were obtained by logistic regression and Cox regression models, respectively.
The study included 619 consecutive AAA patients (12% women; mean age, 72 years), of whom 152 (24.5%) had ruptured AAAs. Endovascular repair was performed in 390 (63%). Rupture (odds ratio [OR], 10.63; 95% confidence interval [CI], 4.80-23.5), open repair (OR, 3.59; 95% CI, 1.69-7.62), renal insufficiency (OR, 2.94; 95% CI, 1.51-3.46), and age (OR, 1.08 per year; 95% CI, 1.09-1.15) were predictors of 30-day mortality. Five-year survival expectancy was 65% for intact AAA and 41% for ruptured AAA (P < .001). Cardiovascular deaths unrelated to the AAA occurred in 35% and cancer-related deaths in 29% of deceased patients. Predictors for late mortality were history of prior malignant disease (hazard ratio, 2.83; 95% CI, 1.99-4.03) and age (hazard ratio, 1.08 per year; 95% CI, 1.05-1.10). After 30 days, only six deaths (1.1%) were AAA related.
Endovascular repair reduced perioperative mortality by threefold, but no survival benefit was observed at long term. After the perioperative period, survival of ruptured AAA and intact AAA patients was not different. Deaths were distributed in similar proportions between cardiovascular and cancer-related causes.
腹主动脉瘤（AAA）修复术后的预期寿命和死亡原因尚未得到充分描述。人口老龄化和二级预防的改善可能改变了这些患者的预后。我们设计了一项回顾性队列研究，以确定AAA完整和破裂后的重要预后、死亡原因及结局差异。
对2003年至2011年在荷兰一所大学机构接受治疗的所有AAA患者进行分析。生存状态来自民事登记数据。死亡原因从死亡证明中获取。主要终点是总死亡率。次要终点是心血管、癌症相关和AAA相关死亡率。围手术期和晚期生存的预测因素分别通过逻辑回归和Cox回归模型获得。
该研究纳入了619例连续的AAA患者（12%为女性；平均年龄72岁），其中152例（24.5%）为破裂性AAA。390例（63%）患者接受了血管内修复。破裂（比值比[OR]，10.63；95%置信区间[CI]，4.80 - 23.5）、开放修复（OR，3.59；95% CI，1.69 - 7.62）、肾功能不全（OR，2.94；95% CI，1.51 - 3.46）和年龄（OR，每年1.08；95% CI，1.09 - 1.15）是30天死亡率的预测因素。AAA完整患者的5年预期生存率为65%，破裂患者为41%（P <.001）。在死亡患者中，与AAA无关的心血管死亡占35%，癌症相关死亡占29%。晚期死亡的预测因素是既往恶性疾病史（风险比，2.83；95% CI，1.99 - 4.03）和年龄（风险比，每年1.08；95% CI，1.05 - 1.10）。30天后，仅6例死亡（1.1%）与AAA相关。
血管内修复使围手术期死亡率降低了三倍，但长期未观察到生存获益。围手术期后，破裂性AAA和完整AAA患者的生存率无差异。心血管和癌症相关原因导致的死亡比例相似。
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