Sevilla Nerea, Clara Albert, Diaz-Duran Carles, Ruiz-Carmona Carlos, Ibañez Sara
Angiology and Vascular Surgery Department, Hospital del Mar, Universitat Autònoma de Barcelona - Universitat Pompeu Fabra, Passeig Marítim 25-29, 080003, Barcelona, Spain.
World J Surg. 2016 May;40(5):1272-8. doi: 10.1007/s00268-015-3377-x.
Endovascular aortic aneurysm repair (EVAR) is a prophylactic procedure, so the decision to operate should consider, as recent guidelines suggest, the life expectancy of the patient. Several models for predicting life span have been already designed, but little is known about how intervened patients evolve in Southern European Countries, where the incidence of coronary artery disease, the main cause of death among these subjects, is low.
We conducted a retrospective analysis of 176 consecutive patients who underwent elective EVAR at the Vascular Surgery Department of the Hospital del Mar (Barcelona, Spain) during 2000-2014. Cox regressions were performed to identify preoperative factors associated with long-term survival after EVAR, and a risk model was developed.
Three- and five-year survival rates were 73.9 and 53.9 %, respectively. During the follow-up, 72 deaths (40.9 %) were registered, cancer being the most frequent cause (41.7 %). Preoperative variables negatively associated with long-term survival were serum creatinine ≥ 150 µmol/L (HR 2.5; 95 % CI 1.4-4.2), chronic obstructive pulmonary disease (HR 1.9; 95 % CI 1.2-3.1), atrial fibrillation (HR 2.0; 95 % CI 1.2-3.4), and prior cancer history (HR 1.9; 95 % CI 1.2-3.1). Distal pulses present in both lower limbs were marginally associated with survival (HR 0.65; 95 % CI 0.4-1.07). The survival predictive model showed a good discrimination capacity (C statistic = 0.703; 95 % CI 0.641-0.765).
Long-term survival of patients submitted to EVAR in our setting was worse than expected and markedly related to cancer. Our study suggests that predictive models for long-term survival after EVAR may be influenced by regional characteristics of the intervened population. This effect should be taken in consideration in the decision-making process of these patients.
血管内主动脉瘤修复术（EVAR）是一种预防性手术，因此正如最近的指南所建议的，手术决策应考虑患者的预期寿命。已经设计了几种预测寿命的模型，但对于在南欧国家接受干预的患者的病情发展情况知之甚少，在这些国家，冠状动脉疾病（这些患者的主要死因）的发病率较低。
我们对2000年至2014年期间在西班牙巴塞罗那市海洋医院血管外科接受择期EVAR手术的176例连续患者进行了回顾性分析。进行Cox回归以确定与EVAR术后长期生存相关的术前因素，并建立了一个风险模型。
三年和五年生存率分别为73.9%和53.9%。在随访期间，登记了72例死亡（40.9%），癌症是最常见的死因（41.7%）。与长期生存呈负相关的术前变量包括血清肌酐≥150µmol/L（HR 2.5；95%CI 1.4 - 4.2）、慢性阻塞性肺疾病（HR 1.9；95%CI 1.2 - 3.1）、心房颤动（HR 2.0；95%CI 1.2 - 3.4）以及既往癌症病史（HR 1.9；95%CI 1.2 - 3.1）。双下肢均存在远端脉搏与生存的相关性较弱（HR 0.65；95%CI 0.4 - 1.07）。生存预测模型显示出良好的区分能力（C统计量 = 0.703；95%CI 0.641 - 0.765）。
在我们的研究环境中，接受EVAR手术的患者的长期生存情况比预期的要差，且与癌症明显相关。我们的研究表明，EVAR术后长期生存的预测模型可能会受到干预人群区域特征的影响。在这些患者的决策过程中应考虑到这种影响。
