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Predicting aortic complications after endovascular aneurysm repair.

Authors :
Karthikesalingam A
Holt PJ
Vidal-Diez A
Choke EC
Patterson BO
Thompson LJ
Ghatwary T
Bown MJ
Sayers RD
Thompson MM
Source :
The British journal of surgery [Br J Surg] 2013 Sep; Vol. 100 (10), pp. 1302-11. Date of Electronic Publication: 2013 Jun 25.
Publication Year :
2013

Abstract

Background: Lifelong surveillance is standard after endovascular repair of abdominal aortic aneurysm (EVAR), but remains costly, heterogeneous and poorly calibrated. This study aimed to develop and validate a scoring system for aortic complications after EVAR, informing rationalized surveillance.<br />Methods: Patients undergoing EVAR at two centres were studied from 2004 to 2010. Preoperative morphology was quantified using three-dimensional computed tomography according to a validated protocol, by investigators blinded to outcomes. Proportional hazards modelling was used to identify factors predicting aortic complications at the first centre, and thereby derive a risk score. Sidak tests between risk quartiles dichotomized patients to low- or high-risk groups. Aortic complications were reported by Kaplan-Meier analysis and risk groups were compared by log rank test. External validation was by comparison of aortic complications between risk groups at the second centre.<br />Results: Some 761 patients, with a median age of 75 (interquartile range 70-80) years, underwent EVAR. Median follow-up was 36 (range 11-94) months. Physiological variables were not associated with aortic complications. A morphological risk score incorporating maximum aneurysm diameter (P < 0·001) and largest common iliac diameter (measured 10 mm from the internal iliac origin; P = 0·004) allocated 75 per cent of patients to a low-risk group, with excellent discrimination between 5-year rates of aortic complication in low- and high-risk groups at both centres (centre 1: 12 versus 31 per cent, P < 0·001; centre 2: 12 versus 45 per cent, P = 0·002).<br />Conclusion: The risk score uses commonly available morphological data to stratify the rate of complications after EVAR. The proposals for rationalized surveillance could provide clinical and economic benefits.<br /> (© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.)

Details

Language :
English
ISSN :
1365-2168
Volume :
100
Issue :
10
Database :
MEDLINE
Journal :
The British journal of surgery
Publication Type :
Academic Journal
Accession number :
23797788
Full Text :
https://doi.org/10.1002/bjs.9177