The fate of patients undergoing surveillance of small abdominal aortic aneurysms
The fate of patients undergoing surveillance of small abdominal aortic aneurysms
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DOI：
10.1016/s1078-5884(98)80150-0
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发表时间：
1998-08-01
影响因子：
5.7
通讯作者：
Magee, TR
中科院分区：
文献类型：
--
作者：
Galland, RB;Whiteley, MS;Magee, TR
目标：越来越多的小腹主动脉瘤 (AAA) 患者被诊断出来。本文的目的是确定那些接受小型 AAA 监测的患者的命运。地点：英国地区综合医院。方法：一项前瞻性研究！已对所有接受监测的患者进行了检查。在第一次咨询时，对患者进行了评估，计算了德斯基评分并注明了转诊来源。研究的终点是动脉瘤的选择性修复、动脉瘤破裂或患者死亡。结果：分析了 267 名患者的详细信息。转诊来源为全科医生（39%），周围血管疾病患者（32%），泌尿外科（21%）。没有人从人口筛查中转介过来。所有患者的破裂、选择性修复或非 AAA 相关死亡的累积 5 年风险分别为 15%、26% 和 46%，对于最初就诊的 AAA 直径小于 4 cm 的患者，分别为 4%、13% 和 38%；对于就诊的 AAA 直径为 4-5.5 cm 的患者，分别为 21%、42% 和 54%。除一名动脉瘤破裂的 II 级患者外，所有患者均不适合或拒绝选择性修复。共有 56 例非 AAA 相关死亡，其中大多数是由于心血管原因造成的。 Detsky 评分低的患者的 5 年生存率为 62%，评分高的患者为 44%。正常人群的年龄/性别匹配 5 年生存率为 80%。结论：总体而言，非 AAA 相关死亡率高于破裂或选择性修复的风险。在考虑选择性修复小 AAA 时，重要的是要记住，与正常人群相比，这组患者的预后较差。
Objectives: 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.Setting: U.K. district general hospital.Methods: 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.Results: 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 fi om 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 II 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 of a normal population at 5 years is 80%.Conclusion: Overall the non-AAA related mortality was greater Bran 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.