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1. Cost of Follow Up After Endovascular Abdominal Aortic Aneurysm Repair in Patients With an Initial Post-Operative Computed Tomography Angiogram Without Abnormalities

Author

Geraedts, Anna C.M., primary, van Dieren, Susan, additional, Mulay, Sana, additional, Vahl, Anco C., additional, Koelemay, Mark J.W., additional, Balm, Ron, additional, Balm, R., additional, Elshof, J.W., additional, Elsman, B.H.P., additional, Hamming, J.F., additional, Koelemay, M.J.W., additional, Kropman, R.H.J., additional, Poyck, P.P., additional, Schurink, G.W.H., additional, de Smet, A.A.E.A., additional, van Sterkenburg, S.M., additional, Ünlü, C., additional, Vahl, A.C., additional, Verhagen, H.J.M., additional, Vriens, P.W.H.E., additional, de Vries, J.P.P.M., additional, Wever, J.J., additional, Wisselink, W., additional, and Zeebregts, C.J., additional

Published
2022
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2. Diminishing Endograft Apposition during Follow-Up Is an Important Indicator of Late Type 1a Endoleak after Endovascular Aneurysm Repair.

Author

Zuidema, Roy, Geraedts, Anna C. M., van Veldhuizen, Willemina A., Mulay, Sana, de Vries, Jean-Paul P. M., Schuurmann, Richte C. L., and Balm, Ron

Subjects
ENDOVASCULAR aneurysm repair, ENDOVASCULAR surgery, COMPUTED tomography
Abstract

Late type 1a endoleaks (T1aELs) after endovascular aneurysm repair (EVAR) are hazardous complications which should be avoided. This study investigated the evolution of the shortest apposition length (SAL) post-EVAR and hypothesised that a declining apposition during follow-up may be an indicator of T1aEL development. Patients with a late T1aEL were selected from a consecutive multicentre database. For each T1aEL patient, the preoperative computed tomography angiography (CTA), first postoperative CTA, and pre-endoleak CTA were analysed. T1aEL patients were matched 1:1 to uncomplicated controls, based on endograft type and follow-up duration. Anatomical characteristics and endograft dimensions, including the post-EVAR SAL, were measured. Included were 28 patients with a late T1aEL and 28 matched controls. The SAL decreased from 11.2 mm (5.6–20.6 mm) to 3.9 mm (0.0–11.4 mm) in the T1aEL group (p = 0.006), whereas an increase in SAL was seen in the control group from 21.3 mm (14.1–25.8 mm) to 25.4 mm (19.0–36.2 mm; p = 0.015). On the pre-endoleak CTA, 18 patients (64%) in the T1aEL group had a SAL < 10 mm, and one (4%) patient in the control group had a SAL < 10 mm on the matched CTAs. Moreover, three mechanisms of decreasing sealing zone were identified, which might be used to determine optimal imaging or reintervention strategies. Diminishing SAL < 10 mm is an indicator for T1aEL during follow-up, it is imperative to include apposition analysis during follow-up. [ABSTRACT FROM AUTHOR]

Published
2023
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3. Post-operative Surveillance and Long Term Outcome after Endovascular Aortic Aneurysm Repair in Patients with an Initial Post-operative Computed Tomography Angiogram Without Abnormalities: the Multicentre Retrospective ODYSSEUS Study

Author

Geraedts, Anna C.M., Mulay, Sana, Vahl, A. C., Verhagen, H. J.M., Wisselink, Willem, de Mik, Sylvana M.L., van Dieren, Susan, Koelemay, M. J.W., Balm, Ron, Balm, R., Elshof, J. W., Elsman, B. H.P., Hamming, J. F., Kropman, R. H.J., Poyck, P. P., Schurink, G. W.H., de Smet, A. A.E.A., van Sterkenburg, S. M., Ünlü, C., Vriens, P. W.H.E., de Vries, J. P.P.M., Wever, J. J., Wisselink, W., Zeebregts, C. J., ​Robotics and image-guided minimally-invasive surgery (ROBOTICS), Man, Biomaterials and Microbes (MBM), Surgery, ACS - Microcirculation, ACS - Atherosclerosis & ischemic syndromes, Epidemiology and Data Science, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, APH - Health Behaviors & Chronic Diseases, Graduate School, Amsterdam Gastroenterology Endocrinology Metabolism, APH - Methodology, Cell biology, Erasmus School of Law, Neurology, and Child and Adolescent Psychiatry / Psychology

Subjects
Endoleak, Angiography, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Blood Vessel Prosthesis Implantation, Treatment Outcome, Risk Factors, Endovascular procedures, Vascular surgical procedures, Humans, Abdominal aortic aneurysm, Surgery, Prospective Studies, Cardiology and Cardiovascular Medicine, Tomography, X-Ray Computed, Aortic Aneurysm, Abdominal, Retrospective Studies
Abstract

Contains fulltext : 252341.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Lifelong imaging surveillance is recommended following endovascular aneurysm repair (EVAR). This study aimed to examine the association between adherence to post-operative surveillance and survival and secondary interventions in patients with an initial post-operative computed tomography angiogram (CTA) without abnormalities. METHODS: All consecutive patients undergoing EVAR for intact abdominal aortic aneurysm (AAA) in 16 hospitals between 2007 and 2012 were identified retrospectively, with follow up until December 2018. Patients were included if the initial post-operative CTA showed no types I - III endoleak, kinking, infection, or limb occlusion. Discontinued follow up was defined as at least one 16 month period in which no imaging surveillance was performed. Primary outcomes were aneurysm related mortality and secondary interventions, and secondary outcome all cause mortality. Kaplan-Meier analysis was used to estimate survival, and Cox regression analyses to identify the association between independent variables and outcome. Sensitivity analyses were performed by varying the definition of continued yearly follow up. The study protocol was published (bmjopen-2019-033584). RESULTS: 1 596 patients (552 continued, 1 044 discontinued follow up) were included with a median (interquartile range) follow up of 89.1 months (52.6). Cumulative aneurysm related, overall, and intervention free survival was 99.4/94.8/96.1%, 98.5/72.9/85.9%, and 96.3/45.4/71.1% at 1, 5, and 10 years, respectively. American Society of Anesthesiologists (ASA) classification (ASA IV hazard ratio [HR] 3.810, 95% confidence interval [CI] 1.296 - 11.198), increase in AAA diameter (HR 3.299, 95% CI 1.408 - 7.729), and continued follow up (HR 3.611, 95% CI 1.780 - 7.323) were independently associated with aneurysm related mortality. The same variables and age (HR 1.063 per year, 95% CI 1.052 - 1.074) were significantly associated with all cause mortality. No difference in secondary interventions was observed between patients with continued vs. discontinued follow up (89/552; 16% vs. 136/1044; 13%; p = .091). Sensitivity analyses showed worse aneurysm related and overall survival in patients with continued follow up. CONCLUSION: Discontinued follow up is not associated with poor outcomes. Future prospective studies are indicated to determine in which patients imaging follow up can be safely reduced.

Published
2022

4. Editor's Choice – Post-operative Surveillance and Long Term Outcome after Endovascular Aortic Aneurysm Repair in Patients with an Initial Post-operative Computed Tomography Angiogram Without Abnormalities: the Multicentre Retrospective ODYSSEUS Study

Author

Geraedts, Anna C.M., primary, Mulay, Sana, additional, Vahl, Anco C., additional, Verhagen, Hence J.M., additional, Wisselink, Willem, additional, de Mik, Sylvana M.L., additional, van Dieren, Susan, additional, Koelemay, Mark J.W., additional, Balm, Ron, additional, Balm, R., additional, Elshof, J.W., additional, Elsman, B.H.P., additional, Hamming, J.F., additional, Koelemay, M.J.W., additional, Kropman, R.H.J., additional, Poyck, P.P., additional, Schurink, G.W.H., additional, de Smet, A.A.E.A., additional, van Sterkenburg, S.M., additional, Ünlü, C., additional, Vahl, A.C., additional, Verhagen, H.J.M., additional, Vriens, P.W.H.E., additional, de Vries, J.P.P.M., additional, Wever, J.J., additional, Wisselink, W., additional, and Zeebregts, C.J., additional

Published
2022
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5. Type 2 Endoleak With or Without Intervention and Survival After Endovascular Aneurysm Repair

Author

Mulay, Sana, primary, Geraedts, Anna C.M., additional, Koelemay, Mark J.W., additional, Balm, Ron, additional, Mulay, Sana, additional, Balm, R., additional, Elshof, J.W., additional, Elsman, B.H.P., additional, Hamming, J.F., additional, Koelemay, M.J.W., additional, Kropman, R.H.J., additional, Poyck, P.P., additional, Schurink, G.W.H., additional, de Smet, A.A.E.A., additional, van Sterkenburg, S.M., additional, Ünlü, C., additional, Vahl, A.C., additional, Verhagen, H.J.M., additional, Vriens, P.W.H.E., additional, de Vries, J.P.P.M., additional, Wever, J.J., additional, Wisselink, W., additional, and Zeebregts, C.J., additional

Published
2021
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7. Analysis of Outcomes After Endovascular Abdominal Aortic Aneurysm Repair in Patients With Abnormal Findings on the First Postoperative Computed Tomography Angiography

Author

Geraedts, Anna C.M., Mulay, Sana, van Dieren, Susan, Koelemay, M. J.W., Balm, R., Elshof, J. W., Elsman, B. H.P., Hamming, J. F., Kropman, R. H.J., Poyck, P. P., Schurink, G. W.H., de Smet, A. A.E.A., van Sterkenburg, S. M., Ünlü, C., Vahl, A. C., Verhagen, H. J.M., Vriens, P. W.H.E., de Vries, J. P.P.M., Wever, J. J., Wisselink, W., Zeebregts, C. J., Geraedts, Anna C.M., Mulay, Sana, van Dieren, Susan, Koelemay, M. J.W., Balm, R., Elshof, J. W., Elsman, B. H.P., Hamming, J. F., Kropman, R. H.J., Poyck, P. P., Schurink, G. W.H., de Smet, A. A.E.A., van Sterkenburg, S. M., Ünlü, C., Vahl, A. C., Verhagen, H. J.M., Vriens, P. W.H.E., de Vries, J. P.P.M., Wever, J. J., Wisselink, W., and Zeebregts, C. J.

Abstract

Purpose: Lifelong follow-up after endovascular abdominal aortic aneurysm repair (EVAR) is recommended due to a continued risk of complications, especially if the first postoperative imaging shows abnormal findings. We studied the long-term outcomes in patients with abnormalities on the first postoperative computed tomography angiography (CTA) following EVAR. Materials and Methods: This is a retrospective study of all consecutive patients who underwent elective EVAR for nonruptured abdominal aortic aneurysm (AAA) between January 2007 and January 2012 in 16 Dutch hospitals with follow-up until December 2018. Patients were included if the first postoperative CTA showed one of the following abnormal findings: endoleak type I–IV, endograft kinking, infection, or limb occlusion. AAA diameter, complications, and secondary interventions during follow-up were registered. Primary endpoint was overall survival, and other endpoints were secondary interventions and intervention-free survival. Kaplan-Meier analyses were used to estimate overall and intervention-free survival. Cox regression analyses were used to identify the association of independent determinants with survival and secondary interventions. Results: A total of 502 patients had abnormal findings on the first postoperative CTA after EVAR and had a median follow-up (interquartile range IQR) of 83.0 months (59.0). The estimated overall survival rate at 1, 5, and 10 years was 84.7%, 51.0%, and 30.8%, respectively. Age [hazard ratio (HR) 1.06, 95% confidence interval (CI) 1.05 to 1.10] and American Society of Anesthesiologists (ASA) classification (ASA IV HR 3.20, 95% CI 1.99 to 5.15) were significantly associated with all-cause mortality. Overall, 167 of the 502 patients (33.3%) underwent 238 secondary interventions in total. Fifty-eight patients (12%) underwent an intervention based on a finding on the first postoperative CTA. Overall survival was 38.4% for patients with secondary interventions and 44.5% for patien

Published
2021

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