作者： R.M Greenhalgh , J Forbes , L.C Brown , A.R Brady , F.G Fowkes
DOI:
关键词: Medicine 、 Clinical endpoint 、 Radiology 、 Randomized controlled trial 、 Aneurysm 、 Elective surgery 、 Operative mortality 、 Small aneurysm 、 Intention-to-treat analysis 、 Hazard ratio 、 Surgery
摘要: BACKGROUND: Early elective surgery may prevent rupture of abdominal aortic aneurysms, but mortality is 5-6%. The risk seems to be low for aneurysms smaller than 5 cm. We investigated whether prophylactic open decreased long-term risks small aneurysms. METHODS: randomly assigned 1090 patients aged 60-76 years, with symptomless 4.0-5.5 cm in diameter undergo early (n=563) or ultrasonographic surveillance (n=527). Patients were followed up a mean 4.6 years. If the group exceeded 5.5 cm, surgical repair was recommended. primary endpoint death. Mortality analyses done by intention treat. FINDINGS: two groups had similar cardiovascular factors at baseline. 93% adhered treatment. 309 died during follow-up. overall hazard ratio all-cause early-surgery compared 0.94 (95% CI 0.75-1.17, p=0.56). 30-day operative 5.8%, which led survival disadvantage these trial. did not differ significantly between 2 4 6 Age, sex, initial aneurysm size modify ratio. INTERPRETATION: Ultrasonographic safe, and does provide advantage. Our results do support policy diameter.