目的:提供最新的,通过选择性腔内修复术治疗腹主动脉瘤(AAA)的八十岁(年龄≥80岁)患者的临床结局的综合证据,与传统的开放式维修相比。
方法:PubMed,Embase,和Scopus数据库进行了系统搜索。该综述考虑了观察性或随机对照试验的研究。纳入的研究是在患有AAA的老年受试者(≥80岁)中进行的,比较了腔内修复和开放手术修复的临床结局和死亡率.那些报告紧急修复的患者的结果被排除在外。感兴趣的主要结果是死亡率和并发症的风险。汇总效应大小报告为分类结果的比值比(OR)和连续结果的加权平均差(WMD)。采用STATA软件进行统计分析。
结果:荟萃分析包括15项研究。与那些接受开放式修复的人相比,接受腔内修复术的患者术后即刻死亡风险显著降低(OR.23,95%CI:.20,.27),总体并发症(OR.30,95%CI:.20,.44),心脏(OR.23,95%CI:.16,.35),肾(OR.29,95%CI:.18,.46),肺(OR.14,95%CI:.09,.21)和出血相关(OR.59,95%CI:.42,.83)并发症。两组在最近一次随访(36个月和60个月)时的死亡风险相似。总失血量(ml)(WMD-1126.47,95%CI:-1497.81,-755.13),手术时间(分钟)(WMD-29.40,95%CI:-56.19,-2.62),在接受血管内修复的患者中,重症监护病房住院时间(天)(WMD-2.27,95%CI:-3.43,-2.12)和总住院时间(天)(WMD-6.64,95%CI:-7.60,-5.68)显著较低.
结论:在这种高风险患者中,腔内修复似乎比开放修复更好。脆弱的人口,关于短期结果。短期死亡风险降低的好处,并发症,在这两种手术方法之间进行选择时,可以考虑更好的围手术期和术后结局。需要随机对照试验来提供关于EVAR对长期生存的影响的可靠证据。
OBJECTIVE: To provide updated, pooled evidence on clinical outcomes among octogenarians (aged ≥80 years) with abdominal aortic aneurysm (AAA) managed by elective endovascular repair, compared to conventional open repair.
METHODS: PubMed, Embase, and Scopus databases were systematically searched. Studies that were either observational or randomized controlled trials were considered for the review. Included studies were conducted in elderly subjects (≥80 years) with AAA, and clinical and mortality outcomes were compared between endovascular and open surgical repair. Those reporting on outcomes of patients with urgent repair were excluded. The primary outcomes of interest were mortality and risk of complications. The pooled effect sizes were reported as odds ratio (OR) for categorical outcomes and weighted mean difference (WMD) for continuous outcomes. STATA software was used for statistical analysis.
RESULTS: The meta-analysis included 15 studies. Compared to those undergoing open repair, patients receiving endovascular repair had significantly reduced risk of immediate post-operative mortality (OR .23, 95% CI: .20, .27), overall complication (OR .30, 95% CI: .20, .44), cardiac (OR .23, 95% CI: .16, .35), renal (OR .29, 95% CI: .18, .46), pulmonary (OR .14, 95% CI: .09, .21) and bleeding related (OR .59, 95% CI: .42, .83) complications. The risk of mortality at latest follow up (at 36 months and 60 months) was similar in the two groups. The total blood loss (ml) (WMD -1126.47, 95% CI: -1497.81, -755.13), operative time (min) (WMD -29.40, 95% CI: -56.19, -2.62), length of intensive care unit stay (days) (WMD -2.27, 95% CI: -3.43, -2.12) and overall hospital stay (days) (WMD -6.64, 95% CI: -7.60, -5.68) was significantly lower in those undergoing endovascular repair.
CONCLUSIONS: Endovascular repair appears to be better than open repair of AAA in this high-risk, frail population, with respect to short term outcomes. The benefits of reduced risk of short term mortality, complications, and better peri and post-operative outcomes may be considered when making a choice between these two surgical approaches. Randomized controlled trials are needed to provide reliable evidence on the effect of EVAR on long term survival.