Diehl J T, Cali R F, Hertzer N R, Beven E G
Ann Surg. 1983 Jan;197(1):49-56.
From 1974 through 1978, 557 patients (mean age: 63 years) underwent Dacron graft replacement of the abdominal aorta at the Cleveland Clinic. Postoperative complications occurred in 110 patients (20%), with mortality rates of 5.1% for those having intact aortic aneurysms, 26% for those with ruptured aneurysms, and 2.3% for those with aortoiliac occlusive disease. Myocardial infarction was the most common cause of postoperative death, affecting 3.1% of the entire series, but all 87 patients who had previously required myocardial revascularization survived subsequent aortic procedures (p less than 0.01). As defined in this investigation, temporary renal failure (7.0%) or pulmonary insufficiency (5.9%) were encountered more frequently than were other complications, but each of these was the singular cause of death in only 0.2% of all patients. Several risk factors significantly influenced postoperative mortality, (p less than 0.01), including age over 60 years, suspected coronary artery disease, serum creatinine greater than 2.0 mg/dl, complementary renal artery revascularization, and aneurysm rupture. In addition, intraoperative blood loss had a statistically valid correlation with postoperative mortality (p less than 0.01), myocardial infarction (p less than 0.010, renal failure (p less than 0.001), and pulmonary insufficiency (p less than 0.001).
1974年至1978年期间，557例患者（平均年龄63岁）在克利夫兰诊所接受了腹主动脉涤纶人工血管置换术。110例患者（20%）出现术后并发症，完整主动脉瘤患者的死亡率为5.1%，动脉瘤破裂患者为26%，主髂动脉闭塞性疾病患者为2.3%。心肌梗死是术后死亡的最常见原因，占整个系列的3.1%，但之前需要进行心肌血运重建的87例患者在随后的主动脉手术中均存活（p<0.01）。在本研究中定义的暂时性肾衰竭（7.0%）或肺功能不全（5.9%）比其他并发症更常见，但这些情况在所有患者中仅各占0.2%的死亡原因。几个危险因素对术后死亡率有显著影响（p<0.01），包括60岁以上、疑似冠状动脉疾病、血清肌酐大于2.0mg/dl、补充性肾动脉血运重建和动脉瘤破裂。此外，术中失血量与术后死亡率（p<0.01）、心肌梗死（p<0.01）、肾衰竭（p<0.001）和肺功能不全（p<0.001）有统计学上的有效关联。
