1 发病率
AAA的发生与很多流行病学因素有关,如年龄、性别、种族、家族史和吸烟等[3]。高龄、男性、白种人、阳性家族史和长期吸烟者的AAA发生率相应增高[4]。在欧洲北部地区,超声筛查显示直径29~49 mm的AAA在75~84岁男性中的患病率达12.5%,在75~84岁女性中患病率为5.2%[5]。
通信作者:郭伟教授 通信作者:陈忠教授 张韬教授 【引用本文】中华医学会外科学分会血管外科学组. 腹主动脉瘤诊断和治疗中国专家共识(2022版)[J]. 中国实用外科杂志,2022,42(4):380-387. 腹主动脉瘤诊断和治疗中国专家共识(2022版) 中华医学会外科学分会血管外科学组 中国实用外科杂志,2022,42(4):380-387 基金项目:国家自然科学基金(No.82170494);科技部国家重点研发计划(No.2020YFC1107701);首都卫生发展科研专项(No.首发2018-1-2062) 通信作者:郭伟,E-mail: pla301dml@vip.sina.com;陈忠,E-mail: chenzhong8658@vip.sina.com 由于AAA病人的诊断、治疗以及管理较为复杂,中华医学会外科学分会血管外科学组于2008年发布了《腹主动脉瘤诊断与治疗指南》。经过十余年的发展,AAA在诊治理念、方式、策略等方面发生了显著变化,为体现学科进展,中华医学会外科学分会血管外科学组组织国内部分专家,结合最新研究结果,经过充分讨论,制订《腹主动脉瘤诊断与治疗中国专家共识(2022版)》,针对AAA的诊断评估、治疗方式、术后随访管理等方面进行阐述,以期指导血管外科医师的临床实践。 1 发病率
2 自然病程
3 诊断
4 AAA的治疗
5 随访管理
参考文献 (在框内滑动手指即可浏览) [1] Wanhainen A,Verzini F,Vanherzeele I,et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms [J]. Eur J Vasc Endovasc Surg,2019,57(1): 8-93. [2] Chaikof EL,Dalman RL,Eskandari MK,et al. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm [J]. J Vasc Surg,2018,67(1): 2-77.e2. [3] Jahangir E,Lipworth L,Edwards TL,et al. Smoking,sex,risk factors and abdominal aortic aneurysms: a prospective study of 18 782 persons aged above 65 years in the Southern Community Cohort Study [J]. J Epidemiol Community Health,2015,69(5): 481-488. [4] Lederle FA,Johanson GR,Wilson SE,et al. The aneurysm detection and management study screening program: validation cohort and final results. Aneurysm Detection and Management Veterans Affairs Cooperative Study Investigators [J]. Arch Intern Med,2000,160(10): 1425-1430. [5] Svensjo S,Bjorck M,Gurtelschmid M,et al. Low prevalence of abdominal aortic aneurysm among 65-year-old Swedish men indicates a change in the epidemiology of the disease [J]. Circulation,2011,124(10): 1118-1123. [6] Sweeting MJ,Thompson SG,Brown LC,et al. Meta-analysis of individual patient data to examine factors affecting growth and rupture of small abdominal aortic aneurysms [J]. Br J Surg,2012,99(5): 655-665. [7] Karkos CD,Mukhopadhyay U,Papakoatas I,et al. Abdominal aortic aneurysm: the role of clinical examination and opportunistic detection [J]. Eur J Vasc Endovasc Surg,2000,19(3): 299-303. [8] Long A,Rouet L,Lindholt JS,et al. Measuring the maximum diameter of native abdominal aortic aneurysms: review and critical analysis [J]. Eur J Vasc Endovasc Surg,2012,43(5): 515-524. [9] Roy J,Labruto F,Beckman MO,et al. Bleeding into the intraluminal thrombus in abdominal aortic aneurysms is associated with rupture [J]. J Vasc Surg,2008,48(5): 1108-1113. [10] Engellau L,Albrechtsson U,Dahlstrom N,et al. Measurements before endovascular repair of abdominal aortic aneurysms. MR imaging with MRA vs. angiography and CT [J]. Acta Radiol,2003,44(2): 177-184. [11] Murakami M,Morikage N,Samura M,et al. Fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography for diagnosis of infected aortic aneurysms [J]. Ann Vasc Surg,2014,28(3): 575-578. [12] Guirguis-Blake JM,Beil TL,Senger CA,et al. Ultrasonography screening for abdominal aortic aneurysms: A systematic evidence review for the U.S. Preventive Services Task Force [J]. Ann Intern Med,2014,160(5): 321-329. [13] Myers J,Mcelrath M,Jaffe A,et al. A randomized trial of exercise training in abdominal aortic aneurysm disease [J]. Med Sci Sports Exerc,2014,46(1): 2-9. [14] Propanolol Aneurysm Trial I. Propranolol for small abdominal aortic aneurysms: results of a randomized trial [J]. J Vasc Surg,2002,35(1): 72-79. [15] Sweeting MJ,Thompson SG,Brown LC,et al. Use of angiotensin converting enzyme inhibitors is associated with increased growth rate of abdominal aortic aneurysms [J]. J Vasc Surg,2010,52(1): 1-4. [16] Takagi H,Yamamoto H,Iwata K,et al. Effects of statin therapy on abdominal aortic aneurysm growth: a meta-analysis and meta-regression of observational comparative studies [J]. Eur J Vasc Endovasc Surg,2012,44(3): 287-292. [17] Wemmelund H,Hogh A,Hundborg HH,et al. Statin use and rupture of abdominal aortic aneurysm [J]. Br J Surg,2014,101(8): 966-975. [18] Baxter BT,Pearce WH,Waltke EA,et al. Prolonged administration of doxycycline in patients with small asymptomatic abdominal aortic aneurysms: report of a prospective (Phase Ⅱ) multicenter study [J]. J Vasc Surg,2002,36(1): 1-12. [19] Karlsson L,Gnarpe J,Bergqvist D,et al. The effect of azithromycin and Chlamydophilia pneumonia infection on expansion of small abdominal aortic aneurysms:A prospective randomized double-blind trial [J]. J Vasc Surg,2009,50(1): 23-29. [20] Kristensen KE,Torp-Pedersen C,Gislason GH,et al. Angiotensin-converting enzyme inhibitors and angiotensin Ⅱ receptor blockers in patients with abdominal aortic aneurysms: nation-wide cohort study [J]. Arterioscler Thromb Vasc Biol,2015,35(3): 733-740. [21] Filardo G,Powell JT,Martinez MA,et al. Surgery for small asymptomatic abdominal aortic aneurysms [J/CD]. Cochrane Database Syst Rev,2015,2015(2):CD001835. [22] Guo Wei,Zhang Tao. Abdominal aortic aneurysm prevalence in China[J/OL]. Endovascular Today,2014:1-7. https:///articles/2014-feb/abdominal-aortic-aneurysm-prevalence-in-china. [23] Kurvers H,Veith FJ,Lipsitz EC,et al. Discontinuous,staccato growth of abdominal aortic aneurysms [J]. J Am Coll Surg,2004,199(5): 709-715. [24] Collaborators R,Bown MJ,Sweeting MJ,et al. Surveillance intervals for small abdominal aortic aneurysms: a meta-analysis [J]. JAMA,2013,309(8): 806-813. [25] Karthikesalingam A,Vidal-Diez A,Holt PJ,et al. Thresholds for abdominal aortic aneurysm repair in england and the United States [J]. N Engl J Med,2016,375(21): 2051-2059. [26] Seiler CM,Deckert A,Diener MK,et al. Midline versus transverse incision in major abdominal surgery: a randomized,double-blind equivalence trial (POVATI: ISRCTN60734227) [J]. Ann Surg,2009,249(6): 913-920. [27] Twine CP,Humphreys AK,Williams IM. Systematic review and meta-analysis of the retroperitoneal versus the transperitoneal approach to the abdominal aorta [J]. Eur J Vasc Endovasc Surg,2013,46(1): 36-47. [28] Goldhammer JE,Zimmerman D. Pro: Activated clotting time should be monitored during heparinization for vascular surgery [J]. J Cardiothorac Vasc Anesth,2018,32(3): 1494-1496. [29] Cao P,De Rango P,Parlani G,et al. Fate of proximal aorta following open infrarenal aneurysm repair [J]. Semin Vasc Surg,2009,22(2): 93-98. [30] Stewart AH,Eyers PS,Earnshaw JJ. Prevention of infection in peripheral arterial reconstruction: A systematic review and meta-analysis [J]. J Vasc Surg,2007,46(1): 148-155. [31] Marconi M,Ceragioli S,Mocellin DM,et al. Open surgical management of hypogastric artery during aortic surgery: Ligate or not ligate? [J]. Ann Vasc Surg,2015,29(4): 780-785. [32] Bjorck M,Troeng T,Bergqvist D. Risk factors for intestinal ischaemia after aortoiliac surgery: A combined cohort and case-control study of 2824 operations [J]. Eur J Vasc Endovasc Surg,1997,13(6): 531-539. [33] Mani K,Bjorck M,Lundkvist J,et al. Improved long-term survival after abdominal aortic aneurysm repair [J]. Circulation,2009,120(3): 201-211. [34] Budtz-Lilly J,Venermo M,Debus S,et al. Editor's Choice - Assessment of International Outcomes of Intact Abdominal Aortic Aneurysm Repair over 9 Years [J]. Eur J Vasc Endovasc Surg,2017,54(1): 13-20. [35] Hertzer NR,Mascha EJ,Karafa MT,et al. Open infrarenal abdominal aortic aneurysm repair: the Cleveland clinic experience from 1989 to 1998 [J]. J Vasc Surg,2002,35(6): 1145-1154. [36] Lederle FA,Freischlag JA,Kyriakides TC,et al. Outcomes following endovascular vs open repair of abdominal aortic aneurysm: A randomized trial [J]. JAMA,2009,302(14): 1535-1542. [37] Greenhalgh RM,Brown LC,Kwong GP,et al. Comparison of endovascular aneurysm repair with open repair in patients with abdominal aortic aneurysm (EVAR trial 1),30-day operative mortality results: randomised controlled trial [J]. Lancet,2004,364(9437): 843-848. [38] Birkmeyer JD,Siewers AE,Finlayson EV,et al. Hospital volume and surgical mortality in the United States [J]. N Engl J Med,2002,346(15): 1128-1137. [39] Bahia SS,Holt PJ,Jackson D,et al. Systematic review and Meta-analysis of long-term survival after elective infrarenal abdominal aortic aneurysm repair 1969-2011: 5 year survival remains poor despite advances in medical care and treatment strategies [J]. Eur J Vasc Endovasc Surg,2015,50(3): 320-330. [40] Schermerhorn ML,Buck DB,O'malley AJ,et al. Long-term outcomes of abdominal aortic aneurysm in the medicare population [J]. N Engl J Med,2015,373(4): 328-338. [41] Parodi JC,Palmaz JC,Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms [J]. Ann Vasc Surg,1991,5(6): 491-499. [42] Nelson P R,Kracjer Z,Kansal N,et al. A multicenter,randomized,controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair (the PEVAR trial) [J]. J Vasc Surg,2014,59(5): 1181-1193. [43] Schermerhorn ML,Bensley RP,Giles KA,et al. Changes in abdominal aortic aneurysm rupture and short-term mortality,1995-2008: A retrospective observational study [J]. Ann Surg,2012,256(4): 651-658. [44] Sobocinski J,Briffa F,Holt PJ,et al. Evaluation of the Zenith low-profile abdominal aortic aneurysm stent graft [J]. J Vasc Surg,2015,62(4): 841-847. [45] Campbell B,Wilkinson J,Marlow M,et al. Long-term evidence for new high-risk medical devices [J]. Lancet,2018,391(10136): 2194-2195. [46] Mcculloch P,Altman DG,Campbell WB,et al. No surgical innovation without evaluation: the IDEAL recommendations [J]. Lancet,2009,374(9695): 1105-1112. [47] Doonan RJ,Girsowicz E,Dubois L,et al. A systematic review and meta-analysis of endovascular juxtarenal aortic aneurysm repair demonstrates lower perioperative mortality compared with open repair [J]. J Vasc Surg,2019,70(6): 2054-2064.e3. [48] Tinelli G,Crea MA,De Waure C,et al. A propensity-matched comparison of fenestrated endovascular aneurysm repair and open surgical repair of pararenal and paravisceral aortic aneurysms [J]. J Vasc Surg,2018,68(3): 659-668. [49] Antoniou GA,Juszczak MT,Antoniou SA,et al. Editor's choice - fenestrated or branched endovascular versus open repair for complex aortic aneurysms: Meta-analysis of time to event propensity score matched data [J]. Eur J Vasc Endovasc Surg,2021,61(2): 228-237. [50] Locham S,Faateh M,Dakour-Aridi H,et al. Octogenarians undergoing open repair have higher mortality compared with fenestrated endovascular repair of intact abdominal aortic aneurysms involving the visceral vessels [J]. Ann Vasc Surg,2018,51:192-199. [51] Norris EJ,Beattie C,Perler BA,et al. Double-masked randomized trial comparing alternate combinations of intraoperative anesthesia and postoperative analgesia in abdominal aortic surgery [J]. Anesthesiology,2001,95(5): 1054-1067. [52] Eisenack M,Umscheid T,Tessarek J,et al. Percutaneous endovascular aortic aneurysm repair:A prospective evaluation of safety,efficiency,and risk factors [J]. J Endovasc Ther,2009,16(6): 708-713. [53] Gimzewska M,Jackson AI,Yeoh SE,et al. Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair [J/CD]. Cochrane Database Syst Rev,2017,2(2):CD010185. [54] Pratesi G,Barbante M,Pulli R,et al. Italian Percutaneous EVAR (IPER) Registry: outcomes of 2381 percutaneous femoral access sites' closure for aortic stent-graft [J]. J Cardiovasc Surg (Torino),2015,56(6): 889-898. [55] Lederle FA,Freischlag JA,Kyriakides TC,et al. Long-term comparison of endovascular and open repair of abdominal aortic aneurysm [J]. N Engl J Med,2012,367(21): 1988-1997. [56] Prinssen M,Verhoeven EL,Buth J,et al. A randomized trial comparing conventional and endovascular repair of abdominal aortic aneurysms [J]. N Engl J Med,2004,351(16): 1607-1618. [57] Lederle FA,Stroupe KT,Kyriakides TC,et al. Long-term cost-effectiveness in the veterans affairs open vs endovascular repair study of aortic abdominal aneurysm: A randomized clinical trial [J]. JAMA Surg,2016,151(12): 1139-1144. [58] Becquemin JP,Pillet JC,Lescalie F,et al. A randomized controlled trial of endovascular aneurysm repair versus open surgery for abdominal aortic aneurysms in low- to moderate-risk patients [J]. J Vasc Surg,2011,53(5): 1167-1173.e1. [59] Veith FJ,Baum RA,Ohki T,et al. Nature and significance of endoleaks and endotension: summary of opinions expressed at an international conference [J]. J Vasc Surg,2002,35(5): 1029-1035. [60] Van Marrewijk C,Buth J,Harris PL,et al. Significance of endoleaks after endovascular repair of abdominal aortic aneurysms: The EUROSTAR experience [J]. J Vasc Surg,2002,35(3): 461-473. [61] White GH,May J,Waugh RC,et al. Type Ⅲ and type Ⅳ endoleak: toward a complete definition of blood flow in the sac after endoluminal AAA repair [J]. J Endovasc Surg,1998,5(4): 305-309. [62] Lin PH,Bush RL,Katzman JB,et al. Delayed aortic aneurysm enlargement due to endotension after endovascular abdominal aortic aneurysm repair [J]. J Vasc Surg,2003,38(4): 840-842. [63] Martin Z,Greenberg RK,Mastracci TM,et al. Late rescue of proximal endograft failure using fenestrated and branched devices [J]. J Vasc Surg,2014,59(6): 1479-1487. [64] Rajani RR,Arthurs ZM,Srivastava SD,et al. Repairing immediate proximal endoleaks during abdominal aortic aneurysm repair [J]. J Vasc Surg,2011,53(5): 1174-1177. [65] Mascoli C,Freyrie A,Gargiulo M,et al. Selective intra-procedural AAA sac embolization during EVAR reduces the rate of type Ⅱ endoleak [J]. Eur J Vasc Endovasc Surg,2016,51(5): 632-639. [66] Lo RC,Buck DB,Herrmann J,et al. Risk factors and consequences of persistent type Ⅱ endoleaks [J]. J Vasc Surg,2016,63(4): 895-901. [67] Turney EJ,Steenberge SP,Lyden SP,et al. Late graft explants in endovascular aneurysm repair [J]. J Vasc Surg,2014,59(4): 886-893. [68] Chakfe N,Diener H,Lejay A,et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 clinical practice guidelines on the management of vascular graft and endograft infections [J]. Eur J Vasc Endovasc Surg,2020,59(3): 339-384. [69] Dellagrammaticas D,Baderkhan H,Mani K. Management of aortic sac enlargement following successful EVAR in a frail patient [J]. Eur J Vasc Endovasc Surg,2016,51(2): 302-308. [70] Mirza TA,Karthikesalingam A,Jackson D,et al. Duplex ultrasound and contrast-enhanced ultrasound versus computed tomography for the detection of endoleak after EVAR: systematic review and bivariate meta-analysis [J]. Eur J Vasc Endovasc Surg,2010,39(4): 418-428. [71] Garg T,Baker LC,Mell MW. Postoperative surveillance and long-term outcomes after endovascular aneurysm repair among medicare beneficiaries [J]. JAMA Surg,2015,150(10): 957-963. [72] Baderkhan H,Haller O,Wanhainen A,et al. Follow-up after endovascular aortic aneurysm repair can be stratified based on first postoperative imaging [J]. Br J Surg,2018,105(6): 709-718. (2022-02-26收稿) |
|
来自: 昵称50910763 > 《重症》