腔内修复术治疗肾下型腹主动脉瘤疗效研究：单中心十年结果

Endovascular aortic repair of infrarenal abdominal aortic aneurysm： a 10-year single center outcomes

目的 探讨评价腔内修复术（EVAR）治疗肾下型腹主动脉瘤（AAA）的长期治疗效果.方法 对解放军总医院血管外科2004年1月至2014年6月收治的符合纳入和排除标准的71 1例接受EVAR治疗的AAA患者资料进行回顾性分析,男性612例,女性99例,平均年龄（69±13）岁.主要研究结果是全因死亡率,次要研究结果是介入相关并发症发生率、二次干预率和手术相关数据.应用Kaplan-Meier生存曲线分析远期生存率和介入相关并发症累积风险,应用Cox多元回归分析影响远期生存的相关因素.结果 74.8％的患者完成有效随访,最长随访时间10.4年,平均随访时间（3.8±3.5）年.共140例患者死亡,全因死亡率为19.7％,介入相关并发症发生率为9.3％,二次干预率为5.3％.Kaplan-Meier生存分析结果显示,术后5年累积生存率为78％（95％ CI：74％-82％）,10年累积生存率为67％ （95％ CI：61％-74％）;术后5年累积血管并发症发生风险为10.5％（95％ CI：7.3％ -13.7％）,10年累积血管并发症发生风险为19.3％（95％ CI：11.9％ -26.0％）.Cox回归分析结果显示,高龄、美国麻醉师协会分级Ⅲ或Ⅳ级、吸烟、糖尿病会增加远期死亡风险（P＜0.05）;高血压可降低远期死亡风险（P＜0.05）.结论 EVAR治疗AAA的远期结果较好.控制相关危险因素,可进一步改善此类患者的预后.

Objective To evaluate the outcome after endovascular aortic repair （EVAR） of abdominal aortic aneurysms （AAA） in single center.Methods A total of 711 AAA patients treated by EVAR in Department of Vascular Surgery, People＇s Liberation Army General Hospital and met the inclusion criteria from January 2004 to June 2014 were followed-up and analyzed.There were 612 male and 99 female patients, with a mean age of （69 ± 13） years in this study group.The primary outcome of the study was allcause mortality, secondary outcome included procedural data, intervention-related morbidity and secondary therapeutic procedures.The endpoint was death.Kaplan-Meier survival analysis were used to analyze longterm survival and cumulative probability of intervention related morbidity.Cox proportional hazards regression was used to analyze factors influenced the survival.Multivariable analysis were adjusted for covariates.Results There were 74.8% of total patients followed up.The longest follow-up period was 10.4 years （mean 3.8 years）.For the primary outcome of all-cause mortality, 140 deaths occurred.Intervention related morbidity was 9.3%, secondary therapeutic procedures was 5.3%.The Kaplan-Meier survival curve showed that cumulative survival is 78% （95% CI： 74% to 82%）in 5 years,67% （95% CI： 61% to 74%）in 10 years and the cumulative probability of intervention related morbidity is 10.5% （95% CI：7.3% to 13.7%）in 5 years, 19.3% （95% CI： 11.9% to 26.0%） in 10 years.Cox proportional hazards regression showed that age 〉 75 years, American Society of Anesthesiologists classification Ⅲ or Ⅳ,smoking, diabetes significantly increase the risk of long-term all-cause mortality, while hypertension significantly decreases the risk.Conclusions Long-term outcome after EVAR of AAA in the study is similar to those advanced studies.The management of risk factors would improve the prognosis of these patients.