Oussoren Fieke K, Holewijn Suzanne, Claessens Niels, van der Veen Daphne, Reijnen Michel Mpj
Department of Surgery, Rijnstate Hospital, Arnhem, the Netherlands.
Department of Pulmonary Medicine, Rijnstate Hospital, Arnhem, the Netherlands.
Vascular. 2020 Oct;28(5):557-567. doi: 10.1177/1708538120921097. Epub 2020 Apr 26.
Elective abdominal aortic aneurysm (AAA) repair is advocated in patients where risk of rupture exceeds the risks of peri-procedural morbidity and mortality. Chronic obstructive pulmonary disease (COPD) is a known risk factor for AAA and increased operative morbidity in general. Since literature on the correlation between the clinical classification of COPD and morbidity following endovascular infrarenal AAA repair (EVAR) is scarce, assessment per individual remains a challenge.
To analyse the pulmonary and all-cause morbidity and mortality in patients with documented COPD and relate this to their GOLD classification.
Sixty-eight patients with COPD, documented by a lung function test, who underwent elective EVAR between July 2002 and July 2018 were retrospectively reviewed. The primary endpoint was the incidence of 30-day pulmonary adverse events. Procedural characteristics, length of hospital stay, pulmonary and all-cause morbidity including major adverse events (MAEs) during follow-up and five-year survival divided per GOLD classification were the secondary endpoints.
There was no statistically significant difference in the incidence of pulmonary adverse events between GOLD I/II and GOLD III/IV patients. There was neither procedural nor 30-day mortality in either group. Through 30 days and 1 year, there was no difference in pulmonary and all-cause morbidity between groups. Three MAEs occurred in the GOLD I/II group versus 2 MAE in the GOLD III/IV group during the first postoperative year. The five-year survival was 66.0%, 60.9% and 61.9% for patients with GOLD I, GOLD II and GOLD III, respectively. Three of four GOLD IV died within the first year after EVAR.
EVAR can be safely performed in patients with COPD, with low 30-day morbidity and mortality rates. Although severe co-morbidity should be taken into account, EVAR seems to be justified in patients with COPD with a GOLD classification I, II or III. Further research should focus on optimising the pulmonary condition in patients selected for EVAR.
对于腹主动脉瘤（AAA）破裂风险超过围手术期发病和死亡风险的患者，提倡进行择期腹主动脉瘤修复术。慢性阻塞性肺疾病（COPD）是AAA的已知危险因素，总体上会增加手术发病率。由于关于COPD临床分类与肾下型腹主动脉瘤腔内修复术（EVAR）后发病率之间相关性的文献较少，对个体进行评估仍然是一项挑战。
分析有记录的COPD患者的肺部及全因发病率和死亡率，并将其与GOLD分级相关联。
回顾性分析2002年7月至2018年7月期间接受择期EVAR手术且经肺功能测试证实患有COPD的68例患者。主要终点是30天肺部不良事件的发生率。次要终点包括手术特征、住院时间、肺部及全因发病率（包括随访期间的主要不良事件（MAE））以及按GOLD分级划分的五年生存率。
GOLD I/II级和GOLD III/IV级患者的肺部不良事件发生率无统计学显著差异。两组均无手术相关及30天死亡率。在30天和1年时，两组间肺部及全因发病率无差异。术后第一年，GOLD I/II组发生3例MAE，GOLD III/IV组发生2例MAE。GOLD I级、GOLD II级和GOLD III级患者的五年生存率分别为66.0%、60.9%和61.9%。GOLD IV级的4例患者中有3例在EVAR术后第一年内死亡。
COPD患者可以安全地进行EVAR手术，30天发病率和死亡率较低。尽管应考虑严重的合并症，但对于GOLD分级为I、II或III级的COPD患者，EVAR似乎是合理的。进一步的研究应集中于优化选择进行EVAR手术患者的肺部状况。
