无症状腹腔大动脉动脉瘤患者的风险分层和治疗选择
Lorenz Meuli1,2,3, Alexander Zimmermann1, Jeppe Kofoed Petersen4
1Department of Vascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
JAMA network open
|April 7, 2025
概括
开放式手术修复 (OSR) 为低风险腹腔大动脉动脉瘤 (AAA) 患者提供更长的生存期,而内血管修复 (EVAR) 对中高风险患者有利. 风险分层是最佳AAA治疗选择的关键.
科学领域:
- 血管外科 血管外科
- 心血管研究研究心血管研究
- 医疗保健服务研究 医疗服务研究
背景情况:
- 开放式手术修复 (OSR) 和内血管修复 (EVAR) 是腹腔大动脉瘤 (AAA) 的主要治疗方法.
- 基于预期寿命和风险分层的最佳患者选择仍然具有挑战性.
- 目前的指导方针建议OSR用于长期预期寿命和EVAR用于更短的预期寿命,但证据有限.
研究的目的:
- 在接受选择性AAA修复的患者中,比较OSR和EVAR之间的整体存活率.
- 评估风险分层对AAA治疗的生存结果的影响.
- 评估二次结果,包括AAA破裂和新的癌症诊断.
主要方法:
- 一项使用丹麦国家卫生登记册从2004年到2023年进行的队列研究.
- 包括60岁以上接受选择性AAA修复的患者.
- 根据年龄,eGFR和COPD分为4组的风险分层,并对并发症平衡进行反向概率加权.
主要成果:
- 在所有风险组中,OSR显示了更高的术后死亡率.
- 与EVAR相比,接受OSR的低风险患者的平均存活时间比EVAR长10个月.
- 与OSR相比,接受EVAR的中高风险患者的平均存活时间比OSR长9个月.
- 在10年AAA破裂或新癌症发病率中,OSR和EVAR之间没有显著差异.
结论:
- 风险分层对于选择最佳的AAA修复策略至关重要.
- 低风险患者的OSR可能优于低风险患者,而EVAR则为中度至高风险患者提供生存益处.
- 这些发现支持腹腔大动脉动脉瘤的个性化治疗方法.
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