腔内修复术治疗80岁以上肾下腹主动脉瘤患者的有效性和安全性分析

Efficacy and safety analysis of endovascular aortic repair of abdominal aortic aneurysms in patients over eighty years old

目的观察腔内修复术（EVAR）治疗80岁以上患者肾下腹主动脉瘤（AAA）的临床疗效，并分析影响远期疗效的因素。方法对2004年1月1日至2013年12月31日符合纳入标准的80岁以上EVAR治疗的96例AAA患者进行随访和分析。主要研究结果为全因死亡，次要研究结果包括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76例（79．2％）患者完成最终有效随访，平均随访时间为3．63年，最长随访时间为10．34年。随访期间共发生27例死亡，远期全因死亡率为28．1％。随访期间共发生介入相关并发症8例（8．3％），并发症包括内漏、脊髓缺血症状等。随访期间共发生二次干预6例，再干预次数6次，二次干预率为6．3％。术后5年累积生存率为64％（95％CI：0．53～0．78），术后10年累积生存率为35％（95％CI：0．15～0．84）。多元COX回归分析显示：ASA评分Ⅲ级和Ⅳ级（HR=8．45，95％CI：1．26～56．55，P〈0．05）、吸烟（HR：2．08，95％CI：0．70—2．63，P〈0．05）、脑血管疾病（HR=2．96，95％CI：1．06～8．25，P〈0．05）显著性增加EVAR治疗AAA远期死亡的风险，高血压显著性降低EVAR治疗AAA远期死亡风险（HR=0．25，95％CI：0．10～0．66，P〈0．05）。结论EVAR手术对于高龄患者是安全的，但术前个体化评估非常重要。

Objective To evaluate the outcome of the endovascular aortic repair （EVAR） of abdominal aortic aneurysms （AAA） in patients over 80 years old and analyze the factors that influence its long-term curative effect. Methods Follow-up visits and analysis were conducted from January 2004 to December 2013 on a total of 96 AAA patients aged over 80 years old who had been treated with EVAR and thus met the inclusion criteria. The primary focus of the study was all-cause mortality and secondary focuses included the rate of intervention-related complications, the rate of secondary interventions and procedural data. The Kaplan-Meier survival curve was used to analyze the long-term survival rate and the cumulative probability of intervention-related complications. The Cox proportional hazards regression model was used to analyze factors that could influence the long-term survival rate. Results Effective follow-up visits were conducted on 76 patients （ 79.2% ）. The patients were tracked for an average of 3.63 years, with the longest follow-up lasting 10. 34 years. During the study, 27 deaths occurred and the all-cause mortality rate was 28. 1%. Furthermore, 8 cases of intervention-related complications （8.3%） were observed, including endoleaks and spinal cord ischemia. A total of 6 secondary interventions were conducted on 6 patients, with the rate of secondary interventions being 6. 3%. The five-year cumulative survival rate was 64% （95% CI：0. 53 - 0. 78） and the ten-year cumulative survival rate was 35% （95% CI： 0. 15 - 0. 84） . The Cox proportional hazards model showed that an ASA classification of Ⅲ/Ⅳ （HR = 8.45,95% CI： 1.26 -56. 55, P 〈 0. 05） , smoking （ HR = 2. 08,95% CI： 0.70 - 2. 63, P 〈 0. 05 ） and cerebrovascular diseases （ HR = 2.96,95%CI： 1.06 -8.25,P 〈 0.05） eould significantly increase the risk of the long-term all-cause mortality of an AAA patient treated with EVAR. While hypertension could significantly deerease the risk （HR = 0. 25,95% CI： 0. 10- 0. 66, P 〈 0. 05 ）. Conclusion EVAR is safe for senior patients with AAA though personalized preoperative assessment is very important.