The Department of Vascular Surgery, Auckland City Hospital, 2 Park Road, Auckland, New Zealand.
University of Auckland, Auckland, New Zealand.
Langenbecks Arch Surg. 2024 Aug 20;409(1):256. doi: 10.1007/s00423-024-03441-6.
Treatment of asymptomatic Abdominal Aortic Aneurysms (AAA) presents a clinical challenge, requiring a delicate balance between rupture risk, patient comorbidities, and intervention-related complications. International guidelines recommend intervention for specific AAA size thresholds, but these are based on historical trials with limited female representation. We aimed to analyse disease characteristics, AAA size at rupture, and intervention outcomes in patients with ruptured AAA from 2009 to 2023 to investigate the gap between guidelines and local realities.
This single-centre retrospective cohort study analysed electronic health records of patients treated for a ruptured AAA, excluding those who were managed palliatively. The study assessed patients' demographics, risk factors, comorbidities, clinical presentation, radiological characteristics, and outcomes.
Of 164 patients (41 females, 123 males, median age 73.5), 93.3% presented with abdominal or back pain. The median AAA size at rupture was 8.0 cm in males and 7.6 cm in females. No significant correlations were found between demographic characteristics, risk factors, AAA size, repair modality, and outcomes. Trends show a decline in AAA prevalence and rupture rates, aligning with global health initiatives. Post-intervention survival rates at 30 days were 70.7% (67.5% in males and 80.0% in females), and at 2 years were 65.85% (61.7% in males and 70.0% in females).
Evolving AAA trends and improved post-intervention survival rates warrant a critical reassessment of existing intervention recommendations. Adjusting intervention thresholds to larger sizes may be justified to optimise the risk-benefit ratio.
无症状腹主动脉瘤（AAA）的治疗带来了临床挑战，需要在破裂风险、患者合并症和干预相关并发症之间取得微妙的平衡。国际指南建议根据特定的 AAA 大小阈值进行干预，但这些阈值是基于历史试验制定的，女性代表性有限。我们旨在分析 2009 年至 2023 年破裂 AAA 患者的疾病特征、破裂时的 AAA 大小以及干预结果，以调查指南与当地实际情况之间的差距。
这是一项单中心回顾性队列研究，分析了接受破裂性 AAA 治疗的患者的电子健康记录，排除了姑息性治疗的患者。该研究评估了患者的人口统计学特征、危险因素、合并症、临床表现、影像学特征和结局。
在 164 名患者（41 名女性，123 名男性，中位年龄 73.5 岁）中，93.3%的患者表现为腹痛或背痛。男性破裂时的 AAA 大小中位数为 8.0cm，女性为 7.6cm。未发现人口统计学特征、危险因素、AAA 大小、修复方式和结局之间存在显著相关性。趋势显示，AAA 的患病率和破裂率下降，与全球健康倡议一致。术后 30 天的生存率为 70.7%（男性为 67.5%，女性为 80.0%），2 年生存率为 65.85%（男性为 61.7%，女性为 70.0%）。
不断演变的 AAA 趋势和改善的术后生存率需要对现有的干预建议进行批判性重新评估。将干预阈值调整到更大的尺寸可能是合理的，以优化风险效益比。
