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2. Meta‐analysis of individual‐patient data from EVAR‐1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

Author

Powell, JT, Sweeting, MJ, Ulug, P, Blankensteijn, JD, Lederle, FA, Becquemin, J‐P, Greenhalgh, RM, Beard, JD, Buxton, MJ, Brown, LC, Harris, PL, Rose, JDG, Russell, IT, Sculpher, MJ, Thompson, SG, Lilford, RJ, Bell, PRF, Whitaker, SC, Poole‐Wilson, the late PA, Ruckley, CV, Campbell, WB, Dean, MRE, Ruttley, MST, Coles, EC, Halliday, A, Gibbs, SJ, Epstein, D, Hannon, RJ, Johnston, L, Bradbury, AW, Henderson, MJ, Parvin, SD, Shepherd, DFC, Mitchell, AW, Edwards, PR, Abbott, GT, Higman, DJ, Vohra, A, Ashley, S, Robottom, C, Wyatt, MG, Byrne, D, Edwards, R, Leiberman, DP, McCarter, DH, Taylor, PR, Reidy, JF, Wilkinson, AR, Ettles, DF, Clason, AE, Leen, GLS, Wilson, NV, Downes, M, Walker, SR, Lavelle, JM, Gough, MJ, McPherson, S, Scott, DJA, Kessell, DO, Naylor, R, Sayers, R, Fishwick, NG, Gould, DA, Walker, MG, Chalmers, NC, Garnham, A, Collins, MA, Gaines, PA, Ashour, MY, Uberoi, R, Braithwaite, B, Davies, JN, Travis, S, Hamilton, G, Platts, A, Shandall, A, Sullivan, BA, Sobeh, M, Matson, M, Fox, AD, Orme, R, Yusef, W, Doyle, T, Horrocks, M, Hardman, J, Blair, PHB, Ellis, PK, and Morris, G

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Clinical Research, Clinical Trials and Supportive Activities, Cardiovascular, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Good Health and Well Being, Aged, Aged, 80 and over, Aortic Aneurysm, Abdominal, Elective Surgical Procedures, Endovascular Procedures, Female, Humans, Male, Middle Aged, Models, Statistical, Multicenter Studies as Topic, Randomized Controlled Trials as Topic, Reoperation, Treatment Outcome, Vascular Grafting, EVAR-1, DREAM, OVER and ACE Trialists, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

BackgroundThe erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation.MethodsAn individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair was conducted to a prespecified analysis plan, reporting on mortality, aneurysm-related mortality and reintervention.ResultsThe analysis included 2783 patients, with 14 245 person-years of follow-up (median 5·5 years). Early (0-6 months after randomization) mortality was lower in the EVAR groups (46 of 1393 versus 73 of 1390 deaths; pooled hazard ratio 0·61, 95 per cent c.i. 0·42 to 0·89; P = 0·010), primarily because 30-day operative mortality was lower in the EVAR groups (16 deaths versus 40 for open repair; pooled odds ratio 0·40, 95 per cent c.i. 0·22 to 0·74). Later (within 3 years) the survival curves converged, remaining converged to 8 years. Beyond 3 years, aneurysm-related mortality was significantly higher in the EVAR groups (19 deaths versus 3 for open repair; pooled hazard ratio 5·16, 1·49 to 17·89; P = 0·010). Patients with moderate renal dysfunction or previous coronary artery disease had no early survival advantage under EVAR. Those with peripheral artery disease had lower mortality under open repair (39 deaths versus 62 for EVAR; P = 0·022) in the period from 6 months to 4 years after randomization.ConclusionThe early survival advantage in the EVAR group, and its subsequent erosion, were confirmed. Over 5 years, patients of marginal fitness had no early survival advantage from EVAR compared with open repair. Aneurysm-related mortality and patients with low ankle : brachial pressure index contributed to the erosion of the early survival advantage for the EVAR group. Trial registration numbers: EVAR-1, ISRCTN55703451; DREAM (Dutch Randomized Endovascular Aneurysm Management), NCT00421330; ACE (Anévrysme de l'aorte abdominale, Chirurgie versus Endoprothèse), NCT00224718; OVER (Open Versus Endovascular Repair Trial for Abdominal Aortic Aneurysms), NCT00094575.

Published
2017

25. A discontinuous Late Cenozoic vegetation record from a maar crater in Auckland, New Zealand

Author

Horrocks, M., Nichol, S.L., Mildenhall, D.C., and Lawlor, I.

Subjects
Geography
Abstract

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1745-7939.2007.00085.x Byline: M. Horrocks (1,2), S. L. Nichol (2), D. C. Mildenhall (3), I. Lawlor (4) Keywords: extinct pollen; Late Cenozoic; New Zealand; volcanism Abstract: Abstract: Presented here are results of analyses of sediments from a maar crater at Matukutureia, south Auckland. The record is discontinuous, reflecting formation of peat on the tuff surface after the eruption. The tuff section of the profile (3-7 million years old) has pollen of numerous extinct taxa and suggests broad-leaf beech (Brassospora) forest with Casuarina and Agathis, and warm temperate conditions. A date of 15 051 [+ or -] 80 14C yr BP from the base of the overlying peat provides a minimum date for the eruption of McLauchlins Hill volcano. We cannot determine the timing of early Polynesian activities. Author Affiliation: (1)Microfossil Research Ltd, 31 Mont Le Grand Rd, Mt Eden, Auckland, New Zealand, (2)School of Geography and Environmental Science, The University of Auckland, Private Bag 92-019, Auckland, New Zealand, (3)Institute of Geological and Nuclear Sciences, PO Box 30-368, Lower Hutt, New Zealand, (4)Auckland Regional Council, Private Bag 92-012, Auckland, New Zealand Article note: E-mail: info@microfossilresearch.com

Published
2007

50. Vascular surgery II

Author

Colgan, M. P., Grouden, M. C., Sheehan, S. J., Kent, P., Murphy, P. G., Moore, D. J., Shanik, D. G., Gaffney, R., Viani, L., Colgan, M., McShane, D., O’Dwyer, T., Walsh, M., Vashisht, R., Sharp, E. J., Coady, A., Sterpetti, A., Greenhalgh, R. M., O’Malley, M. K., Thompson, M. M., Eady, S. L., Budd, J. S., James, R. F. L., Bell, P. R. F., Davies, A. H., Magee, T. R., Thompson, J. F., Condous, M., Lamont, P. M., Baird, R. N., Horrocks, M., Dawson, K., Wlodarczyk, C., Smart, I., Hardy, S., Hamilton, G., Corson, J. D., Synn, A. Y., Hoballah, J. J., Sharp, W. J., Kresowik, T. F., Delaney, C. P., Hurley, J. P., and Wood, A. E.

Published
1992
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