接受大动脉修复的八十岁人的结果
Muhammad Saad Hafeez1, Salim G Habib1, Dana B Semaan1
1Division of Vascular Surgery, University of Pittsburgh, Pittsburgh, PA.
Journal of vascular surgery
|September 15, 2023
概括
选择性腹腔大动脉瘤 (AAA) 修复在八十多岁的患者中经常发生低于尺寸指南的情况,很大一部分脆弱的患者经历了高两年死亡率. 这些结果表明,应该重新考虑这个年龄组的修复尺寸值.
科学领域:
- 血管外科 血管外科
- 老年医学 老年医学
- 公共卫生 公共卫生
背景情况:
- 腹腔大动脉瘤 (AAA) 修复推用于超过特定尺寸值的动脉瘤 (男性为5.5厘米,女性为5厘米).
- 八代人代表越来越多的患者接受AAA修复,需要评估当代的做法和结果在这个老年人群.
研究的目的:
- 评估当代实践选择性腹腔大动脉动脉瘤 (AAA) 修复在八十岁的人.
- 为了评估2年术后的结果,包括死亡率和并发症,八十岁的患者接受内血管 (EVAR) 和开放性大动脉修复 (OAR).
主要方法:
- 分析血管质量倡议数据库 (2012-2019) 对于接受选修EVAR或OAR的80岁以上的人.
- 在EVAR和OAR组之间比较人口统计数据,并发病情况和脆弱性得分.
- 利用考克斯的比例危险模型来确定影响1年和2年死亡率的因素.
主要成果:
- 在八十岁的AAA修复中,很大一部分 (42.0%的EVAR,18.8%的OAR) 低于推尺寸值.
- 25.6%的八十多岁患者被归类为高度脆弱.
- 两年死亡率为EVAR的14.8%,OAR的18.9% (P < .01),OAR的住院死亡率更高 (7.55%对0.87%).
- 高脆弱性独立地与EVAR和OAR的2年死亡率增加有关.
结论:
- 八十岁的选修AAA修复的很大一部分是在既定尺寸标准以下进行的.
- 在这个群体中,特别是脆弱个体中,高两年死亡率挑战了当前的修复指南.
- 在八十岁的人群中,对可选AAA修复的增加大小值的探索是合理的.
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