AAA治疗的循证医学证据.ppt

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结 论 对于小动脉瘤而言,保守治疗未必不是好的选择 EVAR相对于OPEN手术有较大优势,但二次干预率较高 新一代腹主动脉支架具有更优良的性能 谢 谢 30 day mortality was significantly lower for EVAR patients than for open repair patients. The mortality benefit of EVAR increased with increasing age, with an absolute risk reduction of 8.5 per cent for those 85 years old or older. Major medical complications during the perioperative period were less frequent after EVAR. The average length of hospital stay was longer following open surgery. Re-interventions related to AAA were more common during the four-year follow-up period following EVAR. However, patients who underwent open repair were equally more likely to undergo laparotomy-related interventions, including repair of abdominal-wall hernia, lysis of adhesions, and bowel resections. * 循证医学铸就自信之路 AAA治疗的循证医学证据 AAA自然转归 平均增长率: < 4 cm.: 2 mm/ year > 5 cm: 3-4 mm/ year 12月内破裂发生率: * 除外直径,其他增加破裂率的危险因素包括:女性、吸烟、高血压等 小腹主动脉瘤随访频率 此时期的处理以降低危险因素为主。 Guessous I, Periard D, Lorensetti, Cornus J, Ghali WA. The efficacy of pharmacotherapy for decreasing the expansion rate of abdominal aortic aneurysms: a systematic review and meta analysis. PLOS ONE 2008;3:e1895. 手术指征 紧急手术指征 动脉瘤破裂 出现动脉瘤并发症如下肢动脉栓塞 出现明显动脉瘤相关腹痛 择期手术指征 *男性动脉瘤直径大于5.5cm;女性大于5.2cm(欧洲) 动脉瘤直径增加明显: 6周增加0.7cm或1年增加1.0cm者 *Moll FL, Powell JT, Fraedrich G, Verzini F, Haulon S, Waltham M, van Herwaarden JA, Holt PJ, van Keulen JW, Rantner B, Schl?sser FJ, Setacci F, Ricco JB; European Society for Vascular Surgery. Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.Eur J Vasc Endovasc Surg. 2011 Jan;41 Suppl 1:S1-S58. 循证医学热点 1、Small AAA:开放手术 Vs 密切观察; 2、Small AAA:EVAR Vs 密切观察; 3、 AAA:EVAR Vs 开放手术; 4、EVAR:新一代支架的近中期疗效评定。 开放手术 Vs 密切观察 UKSAT (Powell - Lancet 1998) (Powell - Br J Surg 2007) 病例数:1090 年龄:60 – 76 瘤体直径: 4.0 – 5.5 cms 开放手术 Vs 密切观察 死亡率并无显著性差异 手术死亡率为: 5.6% ~ 5.8% 开放手术 Vs 密切观察 ADAM (Lederle NEJM 2002) 病例数:1136 年龄:50-79 瘤体直径: 4.0 –

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