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Predicting risk of rupture and rupture-preventing re-interventions utilising repeated measures on aneurysm sac diameter following endovascular abdominal aortic aneurysm repair

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Title: Predicting risk of rupture and rupture-preventing re-interventions utilising repeated measures on aneurysm sac diameter following endovascular abdominal aortic aneurysm repair
Authors: Grootes, I
Barrett, JK
Ulug, P
Rohlffs, FEV
Laukontaus, SJ
Tulamo, R
Venermo, M
Greenhalgh, RM
Sweeting, MJ
Item Type: Journal Article
Abstract: Background Clinical and imaging surveillance practices following endovascular aneurysm repair (EVAR) for intact abdominal aortic aneurysm (AAA) vary considerably and compliance with recommended lifelong surveillance is poor. The aim of this study was to develop a dynamic prognostic model to enable stratification of patients at risk of future secondary aortic rupture or the need for intervention to prevent rupture (rupture‐preventing reintervention) to enable the development of personalized surveillance intervals. Methods Baseline data and repeat measurements of postoperative aneurysm sac diameter from the EVAR‐1 and EVAR‐2 trials were used to develop the model, with external validation in a cohort from a single‐centre vascular database. Longitudinal mixed‐effects models were fitted to trajectories of sac diameter, and model‐predicted sac diameter and rate of growth were used in prognostic Cox proportional hazards models. Results Some 785 patients from the EVAR trials were included, of whom 155 (19·7 per cent) experienced at least one rupture or required a rupture‐preventing reintervention during follow‐up. An increased risk was associated with preoperative AAA size, rate of sac growth and the number of previously detected complications. A prognostic model using predicted sac growth alone had good discrimination at 2 years (C‐index 0·68), 3 years (C‐index 0·72) and 5 years (C‐index 0·75) after operation and had excellent external validation (C‐index 0·76–0·79). More than 5 years after operation, growth rates above 1 mm/year had a sensitivity of over 80 per cent and specificity over 50 per cent in identifying events occurring within 2 years. Conclusion Secondary sac growth is an important predictor of rupture or rupture‐preventing reintervention to enable the development of personalized surveillance intervals. A dynamic prognostic model has the potential to tailor surveillance by identifying a large proportion of patients who may require less intensive follow‐up.
Issue Date: 1-Sep-2018
Date of Acceptance: 30-Jun-2018
URI: http://hdl.handle.net/10044/1/61941
DOI: https://dx.doi.org/10.1002/bjs.10964
ISSN: 1365-2168
Publisher: Wiley
Start Page: 1294
End Page: 1304
Journal / Book Title: British Journal of Surgery
Volume: 105
Issue: 10
Copyright Statement: © 2018 The Authors. BJS published by John Wiley & Sons Ltd on behalf of BJS Society Ltd. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
Sponsor/Funder: Department of Health
Funder's Grant Number: 07/37/64
Keywords: 11 Medical And Health Sciences
Surgery
Publication Status: Published
Open Access location: https://doi.org/10.1002/bjs.10964
Online Publication Date: 2018-08-07
Appears in Collections:Department of Surgery and Cancer