非手术治疗的肾下腹主动脉瘤患者的晚期生存率

Late Survival in Nonoperated Patients with Infrarenal Abdominal Aortic Aneurysm.

作者信息

Scott S W M, Batchelder A J, Kirkbride D, Naylor A R, Thompson J P

机构信息

Departments of Vascular Anaesthesia and Vascular Surgery, Leicester Royal Infirmary, Leicester, UK.

出版信息

Eur J Vasc Endovasc Surg. 2016 Oct;52(4):444-449. doi: 10.1016/j.ejvs.2016.05.008. Epub 2016 Jun 30.

DOI:10.1016/j.ejvs.2016.05.008

PMID:27374814

Abstract

OBJECTIVE/BACKGROUND: Historical studies report high rupture rates in patients with nonoperated abdominal aortic aneurysms (AAAs) of > 5.5 cm diameter, although a recent audit has questioned this.

METHODS

This was a retrospective review of 138/764 (18%) patients with AAAs evaluated in a preassessment anaesthetic clinic (PAC) between 2006 and 2012, who either did not undergo elective AAA repair or who underwent deferred repair. The remaining 626 underwent repair. Patients with severe comorbidities (dementia, advanced malignancy, life-expectancy < 1 year) and not referred to PAC were excluded.

RESULTS

At a median of 27 months, 71 (52%) died, 36 (51%) following rupture. Cumulative survival, free from rupture or surgery for acute symptoms, was 96% at 1 year, 84% at 3 years, and 64% at 5 years, where baseline AAA diameters were 5.5-6.9 cm. For diameters ≥ 7 cm, survival, free from rupture, was 65% at 1 year, 29% at 3 years, and 0% at 5 years. Median interval to rupture was 47 months (AAA diameter 5.5-6.9 cm) and 21 months where baseline diameters were ≥ 7 cm. Rupture accounted for 32% of late deaths in patients with AAAs of 5.5-5.9 cm diameter, 46% in those with AAAs measuring 6.0-6.9 cm in diameter, and 71% in patients with AAA measuring ≥ 7 cm in diameter.

CONCLUSION

Approximately half of all late deaths in this nonoperated cohort were not AAA related, suggesting that even had repair been undertaken, it would not have prolonged patient survival. The incidence of rupture in "high-risk" patients with an AAA < 7 cm diameter was < 5% at 1 year, thereby giving ample time to optimise risk factors and improve pre-existing medical conditions prior to undertaking a deferred intervention. Even if these patients did not undergo surgical repair, the risk of late rupture was relatively low. By contrast, nonoperated patients with AAAs ≥ 7 cm in diameter face a very high risk of rupture and will probably benefit from elective surgery, with the caveat that a higher procedural risk might have to be incurred.

摘要

目的/背景：历史研究报告称，直径大于5.5厘米的未手术腹主动脉瘤（AAA）患者的破裂率很高，尽管最近的一项审计对此提出了质疑。

方法

这是一项对2006年至2012年间在术前评估麻醉诊所（PAC）接受评估的138例/764例（18%）AAA患者的回顾性研究，这些患者要么未接受择期AAA修复，要么接受了延期修复。其余626例接受了修复。排除患有严重合并症（痴呆、晚期恶性肿瘤、预期寿命<1年）且未转诊至PAC的患者。

结果

在中位时间27个月时，71例（52%）死亡，36例（51%）死于破裂。在基线AAA直径为5.5 - 6.9厘米的患者中，无破裂或因急性症状进行手术的累积生存率在1年时为96%，3年时为84%，5年时为64%。对于直径≥7厘米的患者，无破裂生存率在1年时为65%，3年时为29%，5年时为0%。破裂的中位间隔时间为47个月（AAA直径5.5 - 6.9厘米），基线直径≥7厘米的患者为21个月。在直径为5.5 - 5.9厘米的AAA患者中，破裂占晚期死亡的32%，直径为6.0 - 6.9厘米的AAA患者中占46%，直径≥7厘米的AAA患者中占71%。

结论

在这个未手术的队列中，所有晚期死亡病例中约有一半与AAA无关，这表明即使进行了修复，也不会延长患者的生存期。直径<7厘米的“高危”AAA患者在1年时的破裂发生率<5%，从而有足够的时间在进行延期干预之前优化风险因素并改善已有的医疗状况。即使这些患者未接受手术修复，晚期破裂的风险也相对较低。相比之下，直径≥7厘米的未手术AAA患者面临非常高的破裂风险，可能会从择期手术中获益，但需要注意的是可能会承担更高的手术风险。