Long-term survival after elective repair of infrarenal abdominal aortic aneurysm: Results of a prospective multicentric study
Long-term survival after elective repair of infrarenal abdominal aortic aneurysm: Results of a prospective multicentric study
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DOI：
10.1007/s100169900078
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发表时间：
1997-09-01
影响因子：
1.5
通讯作者：
Kieffer, E
中科院分区：
文献类型：
--
作者：
Koskas, F;Kieffer, E
在1989年，血管外科学术研究协会（AURC）的28个中心报告了所有涉及肾下腹主动脉瘤（AAA）患者的病例，这些患者都活着到达手术室。在总共1107例手术中，834例选择性进行。在1993年和1994年期间，努力联系，并在可能的情况下重新检查794（95.2%）例在这些选择性手术中存活的患者，以建立生存曲线，确定晚期死亡的原因，并确定1989年记录的628个围手术期变量的长期生存的预测值。使用精算和Kaplan-Meier方法计算生存曲线，并与年龄和性别匹配的对照人群中的国家统计记录进行比较。通过单变量统计分析，使用卡方（2）或学生t检验，选择对晚期死亡具有潜在预测价值的变量。在1989年接受择期AAA修复术的794例（92.5%）患者中，1年生存率为93.9 +/- 1.8%，2年生存率为89.5 +/-3.2%，3年生存率为83.5 +/- 3.2%，4年生存率为77.6 +/- 3.9%，5年生存率为66.9 +/- 10.6%。这些比率显著低于对照人群中观察到的比率。心血管疾病的平均年死亡率为1.8%，高于年龄和性别匹配的对照人群。使用考克斯比例风险模型进行的分析显示，以下变量是晚期死亡的显著独立预测因素：动脉瘤直径（P < 0.02），手术入路的选择对一般状况的影响（p < 0.02），左室功能不全（p < 0.02），年龄（p < 0.02），颈动脉闭塞（p < 0.03），采用除前房膜切开术以外的手术入路（p < 0.04），心律失常（p < 0.04），主动脉留置时间（p < 0.05）、心肌缺血的ECG证据（p < 0.05）、动脉瘤上限异常（p < 0.05）和晚期肾功能不全（p < 0.05）。接受成功AAA修复术的患者的预期寿命低于一般人群。虽然死亡通常与AAA或修复手术无关，但心血管疾病导致的发病率高于年龄和性别匹配的对照人群。这些结果表明，在围手术期和长期随访期间更好地管理并发心血管疾病是提高接受AAA修复术患者预期寿命的关键。
During 1989, 28 centers of the Association for Academic Research in Vascular Surgery (AURC) reported all cases involving patients with infrarenal abdominal aortic aneurysm (AAA) who reached the operating room alive. In a total series of 1107 procedures, 834 were performed electively. During 1993 and 1994, an effort was made to contact and, if possible re-examine the 794 (95.2%) patients who survived these elective procedures in order to establish survival curves, determine the causes of late death, and ascertain the predictive value for long-term survival of 628 perioperative variables recorded in 1989. Survival curves were calculated using the actuarial and Kaplan-Meier methods and compared with those obtained from national statistical records in a control population matched for age and sex. Variables with potential predictive value for late death were selected by univariate statistical analysis using either the chi(2) or student t-test. In the group of 794 (92.5%) patients who survived elective AAA repair in 1989, survival rates were 93.9 +/- 1.8% at 1 year, 89.5 +/- 3.2% at 2 years, 83.5 +/- 3.2% at 3 years, 77.6 +/- 3.9% at 4 years, and 66.9 +/- 10.6% at 5 years. These rates were significantly lower than those observed in the control population. The mean annual death rate from cardiovascular disease was 1.8%, which was higher than in the control population matched for age and sex. Analysis using the Cox proportional risk model showed that the following variables were significant, independent predictors of late death: diameter of aneurysm (p < 0.02), choice of surgical approach in function of general status (p < 0.02), left ventricular insufficiency (p < 0.02), age (p < 0.02), carotid artery occlusion (p < 0.03), use of a surgical approach other than lombotomy (p < 0.04), cardiac arrhythmia (p < 0.04), duration of aortic camping (p < 0.05), ECG evidence of myocardial ischemia (p < 0.05), abnormality at the upper limit of the aneurysm (p < 0.05), and advanced renal insufficiency (p < 0.05). Life expectancy in patients that undergo successful AAA repair is lower than in the general population. Although death is often unrelated to AAA or the repair procedure, the incidence of morbidity due to cardiovascular disease is higher than in a control population matched for age and sex. These findings suggest that better management of concurrent cardiovascular disease during the perioperative period and long-term follow-up holds the key to improving life expectancy in patients undergoing AAA repair.