Objective: To investigate the effect of the ratio of the maximum diameter of aneurysm sac to age (R) on the long-term efficacy of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) in patients with infrarenal abdominal aortic aneurysm (IAAA). Methods: This is a retrospective cohort study.The clinical data of 317 patients with IAAA who underwent surgical repair in the Department of Vascular Surgery,the Third Affiliated Hospital of Sun Yat-Sen University from January 2016 to October 2022 were retrospectively collected.There were 266 males and 51 females,aged (69.7±8.3) years (range:37 to 87 years).The R value of the patient was calculated and the receiver operating characteristic(ROC) curve was used to establish a model to calculate the optimal cut-off value.The propensity score matching method was used to match the baseline data of patients in the EVAR and OSR group by 3∶1 (the caliper value was 0.05),and the patients were stratified according to the cutoff value of R,and the postoperative efficacy and survival of the patients were analyzed.The primary endpoint was the total mortality rate,and the secondary endpoints included the occurrence of postoperative complications and reintervention.Pearson χ2 or Fisher 's exact test was used for categorical variables,and t test was used for continuous variables to compare differences between groups.The survival curves of the two groups were described by Kaplan-Meier method. Results: After propensity score matching,198 cases were in the EVAR group and 66 cases were in the OSR group.The ROC model showed that the best cut-off value of R value was 0.90,and the two groups were divided into two layers:R<0.90 and R≥0.90.Among them,112 patients with R<0.90 (84 cases of EVAR,28 cases of OSR);there were 152 patients with R≥0.90 (114 cases of EVAR and 38 cases of OSR).The follow-up time was (23.6±1.6) months (range:1 to 70 months).In the R≥0.90 stratification,the total mortality (26.3% vs.5.3%,P<0.05),complication rate (44.7% vs.26.3%,P<0.05), and secondary intervention rate (31.6% vs.13.2%,P<0.05) in the EVAR group were higher than those in the OSR group.In the R<0.90 stratification,there was no significant difference in the total mortality rate (13.1% vs.10.7%,P<0.05),complication rate (28.6% vs.35.7%,P>0.05) and secondary intervention rate (14.3% vs.21.4%, P>0.05) between the two groups. Conclusions: When R≥0.90 in IAAA patients,OSR maybe more beneficial to patients in terms of survival rate,postoperative complication rate and secondary intervention rate than EVAR.When R<0.90,there are no significant differences in survival rate,complication rate and secondary intervention rate between the two surgical methods.
目的： 探讨瘤体最大径与患者年龄的比值（R）对肾下型腹主动脉瘤（IAAA）患者接受血管腔内修复术（EVAR）与开放手术修复（OSR）远期疗效的影响。 方法： 本研究为回顾性队列研究。回顾性收集2016年1月至2022年10月于中山大学附属第三医院血管外科接受手术修复的317例IAAA患者的临床资料。男性266例，女性51例，年龄（69.7±8.3）岁（范围：37~87岁）。计算所有患者的R值，并利用受试者工作特征（ROC）曲线建立模型，计算最佳截断值。根据手术方式不同将患者分为EVAR组和OSR组。采用倾向性评分匹配法对EVAR组和OSR组患者的基线资料进行3︰1匹配（卡钳值为0.05），并根据R的截断值对患者进行分层，分析患者术后疗效及生存情况。主要研究终点为全因病死率，次要研究终点包括术后并发症发生率及再干预率。分类变量的组间比较采用χ2检验或Fisher确切概率法，定量资料的比较采用独立样本t检验；生存曲线使用Kaplan-Meier法描述，生存差异比较采用Log-rank检验。 结果： 倾向性评分匹配后EVAR组198例，OSR组66例。ROC曲线建立模型得出R值的最佳截断值为0.90，将两组病例分为R<0.90、R≥0.90两层。其中R<0.90的患者112例（EVAR 84例，OSR 28例）；R≥0.90的患者152例（EVAR 114例，OSR 38例）；随访时间为（23.6±1.6）个月（范围：1~70个月）。在R≥0.90分层中，EVAR组在全因病死率（26.3%比5.3%，χ2=7.600，P=0.006）、并发症发生率（44.7%比26.3%，χ2=4.025，P=0.045）、二次干预率（31.6%比13.2%，χ2=4.910，P=0.027）均高于OSR组。而在R<0.90分层中，两组全因病死率（13.1%比10.7%，χ2=0.109，P=0.741）、并发症发生率（28.6%比35.7%，P>0.05）及二次干预率（14.3%比21.4%，P>0.05）的差异无统计学意义。 结论： 对于R≥0.90的IAAA患者，OSR的术后生存率、并发症发生率和二次干预率较EVAR可能更优；对于R<0.90的IAAA患者，两种手术方式的生存率、并发症发生率和二次干预率未见差异。.