Predicting aortic complications after endovascular aneurysm repair.
Br J Surg
; 100(10): 1302-11, 2013 Sep.
Article
en En
| MEDLINE
| ID: mdl-23797788
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.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.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).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.
Texto completo:
1
Bases de datos:
MEDLINE
Asunto principal:
Complicaciones Posoperatorias
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Aneurisma de la Aorta Abdominal
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Procedimientos Endovasculares
Tipo de estudio:
Clinical_trials
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Etiology_studies
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Guideline
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Humans
Idioma:
En
Revista:
Br J Surg
Año:
2013
Tipo del documento:
Article
País de afiliación:
Reino Unido