背景:无症状腹主动脉瘤(AAA)的治疗提出了临床挑战,需要破裂风险之间的微妙平衡,患者合并症,和干预相关并发症。国际准则建议对特定的AAA大小阈值进行干预,但这些都是基于女性代表性有限的历史审判。我们旨在分析疾病特征,破裂时的AAA尺寸,和2009年至2023年AAA破裂患者的干预结局,以调查指南与当地现实之间的差距.
方法:这项单中心回顾性队列研究分析了接受AAA破裂治疗的患者的电子健康记录,不包括那些被姑息管理的人。该研究评估了患者的人口统计学,危险因素,合并症,临床表现,放射学特征,和结果。
结果:164名患者(41名女性,123名男性,中位年龄73.5),93.3%的患者出现腹部或背部疼痛。男性破裂时AAA的中位大小为8.0cm,女性为7.6cm。人口统计学特征之间没有发现显著的相关性,危险因素,AAA尺寸,修复方式,和结果。趋势显示AAA患病率和破裂率下降,与全球卫生倡议保持一致。干预后30天的生存率为70.7%(男性为67.5%,女性为80.0%),2岁时为65.85%(男性为61.7%,女性为70.0%)。
结论:不断发展的AAA趋势和改善的干预后生存率需要对现有的干预建议进行严格的重新评估。将干预阈值调整到更大的大小可能是合理的,以优化风险收益比。
BACKGROUND: Treatment of asymptomatic Abdominal Aortic Aneurysms (AAA) presents a clinical challenge, requiring a delicate balance between rupture risk, patient comorbidities, and intervention-related complications. International guidelines recommend intervention for specific AAA size thresholds, but these are based on historical trials with limited female representation. We aimed to analyse disease characteristics, AAA size at rupture, and intervention outcomes in patients with ruptured AAA from 2009 to 2023 to investigate the gap between guidelines and local realities.
METHODS: This single-centre retrospective cohort study analysed electronic health records of patients treated for a ruptured AAA, excluding those who were managed palliatively. The study assessed patients\' demographics, risk factors, comorbidities, clinical presentation, radiological characteristics, and outcomes.
RESULTS: Of 164 patients (41 females, 123 males, median age 73.5), 93.3% presented with abdominal or back pain. The median AAA size at rupture was 8.0 cm in males and 7.6 cm in females. No significant correlations were found between demographic characteristics, risk factors, AAA size, repair modality, and outcomes. Trends show a decline in AAA prevalence and rupture rates, aligning with global health initiatives. Post-intervention survival rates at 30 days were 70.7% (67.5% in males and 80.0% in females), and at 2 years were 65.85% (61.7% in males and 70.0% in females).
CONCLUSIONS: Evolving AAA trends and improved post-intervention survival rates warrant a critical reassessment of existing intervention recommendations. Adjusting intervention thresholds to larger sizes may be justified to optimise the risk-benefit ratio.