Galland R B, Whiteley M S, Magee T R
Department of Surgery, Royal Berkshire Hospital, Reading, U.K.
Eur J Vasc Endovasc Surg. 1998 Aug;16(2):104-9. doi: 10.1016/s1078-5884(98)80150-0.
Increasing numbers of patients with small abdominal aortic aneurysms (AAA) are being diagnosed. The aim of this paper is to define the fate of those patients undergoing surveillance of small AAAs.
U.K. district general hospital.
A prospective study has been carried out of all patients undergoing surveillance. At the time of the first consultation the patient was assessed, a Detsky score calculated and the referral source noted. End points of the study were elective repair of the aneurysm, aneurysm rupture or death of the patient.
Details of 267 patients were analysed. The referral source was general practitioner in 39%, patients with peripheral vascular disease in 32% and department of urology in 21%. None were referred from population screening. The cumulative 5-year risks of rupture, elective repair or non-AAA related deaths were 15%, 26% and 46% for all patients, 4%, 13% and 38% for patients initially presenting with AAA less than 4 cm diameter and 21%, 42% and 54% for patients presenting with an AAA 4-5.5 cm diameter. All but one of 11 patients whose aneurysm ruptured were unfit or had declined elective repair. There were 56 non-AAA related deaths, the majority due to cardiovascular causes. Those patients with low Detsky scores had a 5-year survival of 62%, those with high scores 44%. The age/sex matched survival or a normal population at 5 years in 80%.
Overall the non-AAA related mortality was greater than the risks of rupture or elective repair. It is important to bear in mind the poor prognosis of this group of patients compared with a normal population when considering elective repair of small AAAs.
诊断出患有小腹部主动脉瘤（AAA）的患者数量日益增多。本文旨在明确接受小AAA监测的患者的转归情况。
英国地区综合医院。
对所有接受监测的患者进行了一项前瞻性研究。在首次会诊时对患者进行评估，计算德茨基评分并记录转诊来源。研究的终点是动脉瘤的择期修复、动脉瘤破裂或患者死亡。
分析了267例患者的详细情况。转诊来源为全科医生的占39%，外周血管疾病患者占32%，泌尿外科占21%。无一例来自人群筛查。所有患者破裂、择期修复或非AAA相关死亡的累积5年风险分别为15%、26%和46%，初始表现为直径小于4 cm的AAA患者为4%、13%和38%，表现为直径4 - 5.5 cm的AAA患者为21%、42%和54%。11例动脉瘤破裂的患者中，除1例之外均不适合或拒绝择期修复。有56例非AAA相关死亡，大多数死于心血管原因。德茨基评分低的患者5年生存率为62%，评分高的患者为44%。年龄/性别匹配的正常人群5年生存率为80%。
总体而言，非AAA相关死亡率高于破裂或择期修复的风险。在考虑对小AAA进行择期修复时，与正常人群相比，牢记这组患者的预后较差很重要。
