80岁及以上腹主动脉瘤患者腔内覆膜支架修复术后生存分析

Survival analysis of patients with abdominal aortic aneurysm aged 80 years and over after endovascular aortic aneurysm repair

目的探讨80岁及以上腹主动脉瘤(AAA)患者腔内覆膜支架修复术(EVAR)后短期及远期生存情况的危险因素。方法收集2011年9月至2019年1月四川大学华西医院收治的175例行EVAR的80岁及以上AAA患者临床资料。首要短期结局指标为30 d病死率。采用多因素Logistic及Cox比例风险回归模型确定短期及远期结局的独立危险因素。结果175例80岁及以上AAA患者EVAR后30 d病死率为3.43%(6/175)。单因素分析结果显示,合并充血性心力衰竭和慢性肾脏病4~5期与80岁及以上AAA患者EVAR后30 d病死可能有关(P<0.05);多因素分析结果显示,合并充血性心力衰竭和慢性肾脏病4~5期均是80岁及以上AAA患者EVAR后30 d病死的独立危险因素(P<0.05)。单因素分析结果显示,年龄、冠状动脉支架植入、充血性心力衰竭、心律不齐、动脉瘤最大直径均与80岁及以上AAA患者EVAR后的远期生存情况可能有关(P<0.05);将单因素分析中差异有统计学意义的因素作为自变量,将术后远期预后情况作为因变量纳入Cox风险比例回归模型进行分析,结果显示,80岁及以上、合并充血性心力衰竭、心律不齐、动脉瘤最大直径均是80岁及以上AAA患者EVAR后远期生存情况的独立危险因素(P<0.05)。结论对于术前合并充血性心力衰竭及慢性肾脏病4~5期的80岁及以上AAA患者,需适当提高其AAA腔内干预指征。高龄、充血性心力衰竭、心律不齐和动脉瘤最大直径均是80岁及以上AAA患者EVAR后远期生存情况的独立危险因素,应加强对此类患者的随访及心脑血管风险管理。

Objective To investigate the short-term and long-term survival risk factors of patients with abdominal aortic aneurysm(AAA)aged 80 years and older after endovascular aortic aneurysm repair(EVAR).Method The clinical data of 175 patients with AAA who underwent EVAR who were admitted to the West China Hospital of Sichuan University from September 2011 to January 2019 were collected.The primary short-term outcome was the 30-day mortality rate.Multivariate Logistic and Cox proportional hazards regression models were used to determine independent risk factors for short-term and long-term outcomes.Result The 30-day mortality rate of 175 patients with AAA aged 80 years and older after EVAR was 3.43%(6/175).The results of the univariate analysis presented that congestive heart failure and chronic kidney disease stages 4 to 5 may be associated with the death of AAA patients 80 years and older at 30 days after EVAR(P<0.05);the results of multivariate analysis showed that the combined congestive heart failure Stages 4 to 5 of chronic kidney disease were independent risk factors for 30 days after EVAR in AAA patients 80 years and older(P<0.05).Univariate analysis indicated that age,coronary stent placement,congestive heart failure,arrhythmia,and the maximum diameter of aneurysm may be related to the long-term survival of AAA patients 80 years and older after EVAR(P<0.05).Using the factors with statistical significance in the univariate analysis were as independent variables,and the long-term prognosis after surgery as the dependent variable,the Cox risk proportional regression model was built based on the foregoing parameters and the results showed that older age,congestive heart failure,and arrhythmia The maximum diameter of aneurysm is an independent risk factor for long-term survival after EVAR in AAA patients 80 years and older(P<0.05).Conclusion For AAA patients aged 80 and older with congestive heart failure and chronic kidney disease stage 4 to 5 before surgery,the indications for AAA intracavitary intervention should be appropriately strict.Elderly,congestive heart failure,arrhythmia,and the largest diameter of aneurysm are all independent risk factors for long-term survival after EVAR in AAA patients aged 80 and older.In conclusion,postoperative follow-up and cardiovascular risk management for such patients should be strengthened and paid more attention.