80 岁以上患者单纯性腹主动脉瘤腔内修复术后的生存情况与一般 80 岁以上无腹主动脉瘤人群相似。
Survival After Uncomplicated EVAR in Octogenarians is Similar to the General Population of Octogenarians Without an Abdominal Aortic Aneurysm.
机构信息
Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands; School of Medicine, Faculty of Health, Universidad Industrial de Santander UIS, Bucaramanga, Colombia.
Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, the Netherlands.
出版信息
Eur J Vasc Endovasc Surg. 2020 May;59(5):740-747. doi: 10.1016/j.ejvs.2020.01.026. Epub 2020 Feb 27.
OBJECTIVE
Long term survival after endovascular aortic aneurysm repair (EVAR) in octogenarians remains unclear. This was evaluated by comparing octogenarians after EVAR with a matched group of octogenarians without an abdominal aortic aneurysm (AAA) from the Rotterdam Study (RS). The influence of complications after EVAR on survival was also studied with the aim of identifying risk factors for the development of complications in octogenarians.
METHODS
Using propensity score matching (PSM), 83 EVAR octogenarians were matched for comorbidities with 83 octogenarians from the RS, and survival was compared between these two groups using Cox proportional hazard analysis. Then, complications were studied, defined as cardiac or pulmonary, renal deterioration, access site bleeding, acute limb ischaemia or bowel ischaemia, within 30 days of surgery between 83 EVAR octogenarians and 475 EVAR non-octogenarians. Also, the difference in baseline characteristics between the octogenarians with and without complications after EVAR were studied, and survival was compared between the RS controls and the complicated and uncomplicated EVAR octogenarians separately.
RESULTS
The total EVAR octogenarian population did not show an increased mortality risk compared with RS octogenarian controls (hazard ratio [HR] 1.28, 95% confidence interval [CI] 0.84-1.97). Post-operative complications occurred in 22 octogenarians (27%) and 59 non-octogenarians (12.4%, p < .001), mainly cardiac, pulmonary, and bleeding complications. All baseline characteristics were similar in the complicated EVAR octogenarians compared with the uncomplicated EVAR octogenarians. After uncomplicated EVAR, octogenarians had a similar survival compared with the RS controls (HR 1.09, 95% CI 0.68-1.77), but after complicated EVAR their mortality risk increased significantly (HR 1.93, 95% CI 1.06-3.54).
CONCLUSION
After standard EVAR, the life expectancy of octogenarians is the same as that of a matched group from the general population without an AAA, provided they do not develop early post-operative complications. Patient selection and meticulous peri-operative care are key.
目的
腔内修复术（EVAR）后 80 岁以上老年人的长期生存情况尚不清楚。本研究通过比较 EVAR 后 80 岁以上老年人与鹿特丹研究（RS）中无腹主动脉瘤（AAA）的 80 岁以上老年人的匹配组，来对此进行评估。还研究了 EVAR 后并发症对生存的影响，目的是确定 80 岁以上老年人发生并发症的危险因素。
方法
采用倾向评分匹配（PSM），将 83 名 EVAR 后 80 岁以上老年人与 RS 中的 83 名 80 岁以上老年人按合并症进行匹配，并使用 Cox 比例风险分析比较两组的生存情况。然后，研究了 83 名 EVAR 后 80 岁以上老年人与 475 名非 80 岁以上 EVAR 患者术后 30 天内的心脏或肺部、肾脏恶化、入路部位出血、急性肢体缺血或肠缺血等并发症，并比较了 EVAR 后有并发症和无并发症的 80 岁以上老年人之间的基线特征差异，以及 RS 对照组与有并发症和无并发症的 EVAR 后 80 岁以上老年人的生存情况。
结果
与 RS 80 岁以上老年人对照组相比，总体 EVAR 后 80 岁以上老年人人群的死亡率没有增加（风险比 [HR] 1.28，95%置信区间 [CI] 0.84-1.97）。22 名 80 岁以上老年人（27%）和 59 名非 80 岁以上老年人（12.4%）发生术后并发症（p<.001），主要为心脏、肺部和出血并发症。与无并发症的 EVAR 后 80 岁以上老年人相比，有并发症的 EVAR 后 80 岁以上老年人的所有基线特征相似。无并发症的 EVAR 后，80 岁以上老年人的生存率与 RS 对照组相似（HR 1.09，95%CI 0.68-1.77），但有并发症的 EVAR 后，他们的死亡率显著增加（HR 1.93，95%CI 1.06-3.54）。
结论
在标准 EVAR 后，如果 80 岁以上老年人没有发生早期术后并发症，那么他们的预期寿命与一般人群中无 AAA 的患者相同。患者选择和细致的围手术期护理是关键。
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