Análisis de la supervivencia tardía de los pacientes con aneurisma de aorta abdominal infrarrenal

Resumen

Objetivo

Estudio comparativo de la supervivencia a largo plazo de los pacientes diagnosticados de aneurisma de aorta abdominal iufrarrenal, intervenidos y no intervenidos por alto riesgo quirúrgico, y evaluación de las causas de mortalidad.

Material y métodos

Análisis retrospectivo de 190 pacientes con diagnóstico de Aneurisma de aorta infrarrenal. El 59,4% eran asintomáticos, el 14,9% sintomáticos y el 25,7% estaban rotos. Se intervinieron 161 pacientes (49 rotos) y 29 no se operaron por alto riesgo. Se compara la probabilidad de supervivencia de los pacientes que sobrevivieron a la cirugía electiva con la de los pacientes no intervenidos por alto riesgo. Se analiza la supervivencia acumulada de los pacientes intervenidos de forma electiva con los intervenidos por rotura, tras excluir los éxitus peroperatorios. Finalmente, se analiza la influencia de determinados factores de riesgo en la mortalidad a largo plazo en pacientes intervenidos de forma electiva.

Resultados

La probabilidad de supervivencia acumulada a 1, 3 y 5 años para el grupo de pacientes intervenidos fue del 83%, 70% y 70%; y para el grupo de no intervenidos por alto riesgo, del 69%, 26% y 13% (p<0,0001). No existió diferencia estadística significativa en la supervivencia de los pacientes que sobrevivieron a la cirugía al comparar los grupos de pacientes intervenidos electivamente o por rotura.

Conclusiones

La supervivencia a largo plazo en los pacientes que sobreviven a la cirugía no difiere si ésta es por AAA roto o no roto y, a su vez, ésta es significativamente mayor que en el caso de los pacientes no intervenidos. Ninguno de los factores de riesgo analizados influyeron de forma significativa en la mortalidad a largo plazo.

Summary

Objetive

A long-term survñval study in operated and non-operated patients with infrarenal abdominal aortic aneurysms, and an assessment of mortality causes.

Material and methods

Two hundred and twenty patients (209 men and 11 women) with infrarenal aortic aneurysms treated in our hospital from 1992 to 1997 were retrospectively studied. There were 62.4% asymptomatic, 12.4% symptomatic, and 25.2% ruptured aneurysms. One hundred and sixty-one patients (49 xvith ruptured aneurysms) were operated on, with an operative mortality of 7.2% in non-ruptured and 61.2% in ruptured aneurysms. Twentynine patients were not operated on because of their risk. Survival probability was compared between patients surviving after surgical procedures and patients that were not operated on because of their risk, and mortality causes were analyzed in both groups. Long-term survival was compared in patients surgically treated for non-ruptured AAA and ruptured AAA, excluding perioperative deaths. Finally, influence of some risk factors on long-term mortality in electively operated patients was assessed.

Results

Cumulative survival probability at 1,3 and 5 years in surgically-treated patients was 83%, 70%, and 70%, Whereas in non-surgically-treated patients because of risk was 69%, 26%, and 13% (p<0.0001). No survival difference was found in patients surviving after surgical procedures for ruptured and non-ruptures AAA. Main mortality cause was cancer in the whole group.

Conclusions

Long-term survival in patients surviving after surgical procedures is the same for ruptured and non-ruptured AAA, and it is significantly higher than in non-operated patients. No significant influence was observed for risk factors on long-term mortality.