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首页> 外文期刊>Vascular and endovascular surgery >Open aneurysm repair in elderly patients not candidates for endovascular repair (EVAR): Comparison with patients undergoing EVAR or preferential open repair.
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Open aneurysm repair in elderly patients not candidates for endovascular repair (EVAR): Comparison with patients undergoing EVAR or preferential open repair.

机译：不适合进行血管内修复（EVAR）的老年患者的开放性动脉瘤修复：与接受EVAR或优先开放性修复的患者进行比较。

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The authors reviewed a 2-year experience with abdominal aortic aneurysm (AAA) repair to determine if patients who were excluded from endovascular aneurysm repair (EVAR) because of anatomic criteria (Group III) represented a higher risk for subsequent open aneurysm repair than either patients undergoing EVAR (Group II) or those patients who preferentially underwent open repair (Group I). Between January 2001 and December 2003, 107 patients underwent AAA repair. Open repair was recommended in patients <70 years of age and without significant comorbidities (Group I). There were 35 patients in Group I; 72 patients were evaluated for EVAR; 29 patients underwent EVAR (Group II), and 43 were excluded and underwent open repair (Group III). Exclusion criteria were those recommended by the graft manufacturers. Patients in Group I were significantly younger than those in Groups II and III (p < 0.0001). Gender, incidence of diabetes, and hypertension were similar in all groups. Patients in Group III had a greater incidence of coronary artery disease (CAD) than those in Groups I and II, trending toward statistical significance (p = 0.06). Aneurysm size in Group II was statistically smaller than in Group I or III. Group III had significantly more complications (25.6% vs 5.7% and 6.9%) than either Group I or II (p < 0.015). Cardiac complications were similar in all groups. Three patients in Group III required prolonged intubation and 3 in Group III developed renal insufficiency. A history of CAD was predictive of complications (21.8% vs 5.8%, p < 0.024), as was inclusion in Group III. There were 2 deaths in this series, both in Group III. Length of stay was significantly less in Group II (4.17 +/-2.36 days) than in Group I (6.57 +/-1.84 days) or Group III (12.30 +/-9.82 days) (p = 0.0001). Open aneurysm repair can be safely performed in younger good-risk patients (Group I) with results equivalent to EVAR (Group II) but with slightly longer length of stay (LOS). In older patients with suitable anatomy EVAR can be performed with minimal morbidity and short LOS. Older patients not suitable for EVAR (Group III) constitute a higher risk group of patients because of increased incidence of CAD and the need for more complex repairs. However, the mortality rate in this group was only 4.6%.
机译：作者回顾了2年的腹主动脉瘤（AAA）修复经验，以确定由于解剖学标准（III组）而被排除在血管内动脉瘤修复（EVAR）之外的患者是否比任何一位患者都具有更高的后续开腹动脉瘤修复风险接受EVAR治疗的患者（II组）或优先接受开放式修复的患者（I组）。在2001年1月至2003年12月之间，有107例患者接受了AAA修复。推荐<70岁且无明显合并症的患者进行开放性修复（I组）。第一组中有35例患者;对72名患者进行了EVAR评估; 29例患者接受了EVAR（第二组），其中43例被排除并接受了开放性修复（第三组）。排除标准是移植物制造商推荐的标准。第一组的患者比第二组和第三组的患者显着年轻（p <0.0001）。所有组的性别，糖尿病发生率和高血压均相似。第三组患者的冠状动脉疾病（CAD）发病率高于第一和第二组，具有统计学意义（p = 0.06）。统计上，第二组的动脉瘤大小小于第一或第三组。第三组的并发症明显多于第一组或第二组（25.6％分别为5.7％和6.9％）（p <0.015）。所有组的心脏并发症相似。第三组中的三名患者需要延长插管时间，第三组中的三名患者出现肾功能不全。 CAD的病史可预测并发症的发生率（21.8％对5.8％，p <0.024），也包括在第三组中。第三组有2人死亡。组II（4.17 +/- 2.36天）的住院时间明显少于组I（6.57 +/- 1.84天）或组III（12.30 +/- 9.82天）（p = 0.0001）。可以在年轻的高危患者（I组）中安全地进行开放性动脉瘤修复，其结果与EVAR（II组）相同，但住院时间略长（LOS）。在具有适当解剖结构的老年患者中，EVAR的发病率极低且LOS较短。不适合使用EVAR的年龄较大的患者（III组）由于CAD的发生率增加和需要进行更复杂的修复，因此构成了较高的患者风险类别。但是，该组的死亡率仅为4.6％。

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