[Abdominal aortic aneurysm discovered in a patient with renal insufficiency. A decision analysis].
Decision analysis is an explicit and quantitative technique which is particularly well suited for medical problems involving multiple complex clinical features. In this article, a decision analysis model was used to measure the risks and benefits between different therapeutic options, for a patient with a 4 cm diameter asymptomatic abdominal aortic aneurysm and concomitant end-stage renal failure. A Markov model was built to stimulate the natural history of abdominal aortic aneurysm, its risk of rupture, and the age-dependent dialysis-related mortality. Despite end-stage renal disease that limits life expectancy and increases the surgical risk, the model suggests that surgical resection of the aneurysm (immediate, or delayed if the diameter exceeds 5 cm in diameter) would result in greater life expectancy compared with therapeutic abstention unless the surgical risk exceeds 8.5% and 22%, respectively. Moreover, the gain in life expectancy between immediate and delayed surgery is not significant, and individual decision-making between these two options should include additional elements representing patients' preference. In conclusion, this model emphasizes the usefulness of decision analysis as a decision aid to medical problem-solving. The Markov simulation, which represents in a realistic manner the natural history of aortic aneurysm, and sensitivity analyses reinforce the credibility of this approach.
Sarasin
F P
FP
Département de Médecine, Hôpital Cantonal Universitaire, Genève, Suisse.
Junod
A F
AF
D017544:Aortic Aneurysm, Abdominal / Q000209:etiology* / Q000601:surgery / Q000628:therapy; D003661:Decision Support Techniques; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
Découverte d'un anévrisme de l'aorte abdominale chez un insuffisant rénal. Une analyse décisionnelle.