Aneurysm Sac Shrinkage after Endovascular Repair: Predictive Factors and Long-Term Follow-Up

Soler, Raphaël; Bartoli, Michel; Mancini, Julien; Lerussi, G.; Thevenin, Benjamin; Sarlon-Bartoli, G.; Magnan, Pierre-Édouard

doi:10.1016/j.avsg.2014.12.016

Cited by 24 publications

(51 citation statements)

References 22 publications

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“…8,16,17 In addition, aneurysm shrinkage during early follow-up is also associated with a reduced likelihood of secondary interventions. 18 Our findings justify a more tailored follow-up protocol as well. Of the 4.1% (n ¼ 6) of our patients who needed a secondary intervention after 5 years, only four patients presented with an endoleak.…”

Section: Discussionmentioning

confidence: 54%

Late single-center outcome of the Talent Abdominal Stent Graft after a decade of follow-up

Mannetje

Broos

Poppel

et al. 2016

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 54%

Late single-center outcome of the Talent Abdominal Stent Graft after a decade of follow-up

Mannetje

Broos

Poppel

et al. 2016

Journal of Vascular Surgery

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“…The 22 cohort studies published in full were of mixed quality (Figure 3). 40,41,[68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85][86][87] The individual study-level results are detailed in Appendix 6. For the majority of studies, over half or more of the ReBIP criteria were not met, or the information provided in the studies was insufficient to determine if the criteria were met, and were, therefore, judged as being of low or moderate quality.…”

Section: Cohort Studiesmentioning

confidence: 99%

“…Nine of the included studies were conducted in the USA, 40,[69][70][71]73,80,81,87,88 six studies were conducted in Italy, 66,75,76,83,86,89 three studies were conducted in Germany, 68,77,84 three studies were conducted in the UK, 41,78,82 two studies were conducted in France, 72,85 one study was conducted in the Czech Republic, 79 one study was conducted in Norway 67 and one study was conducted throughout Europe. 74 The location was not reported in one study.…”

Section: Countrymentioning

confidence: 99%

“…72 Mean follow-up ranged between 14 months [interquartile range (IQR) 7-27 months; range 1-46 months] 83 and 55 months [standard deviation (SD) 36 months]. 85 Seven studies had mean or median follow-up assessment periods that were > 36 months. 41,[66][67][68]78,85,90 Participants A total of 7946 participants were assessed among the 27 included studies.…”

Section: Length Of Follow-upmentioning

confidence: 99%

“…85 Seven studies had mean or median follow-up assessment periods that were > 36 months. 41,[66][67][68]78,85,90 Participants A total of 7946 participants were assessed among the 27 included studies. The characteristics of the patients' aneurysm type varied.…”

Section: Length Of Follow-upmentioning

confidence: 99%

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Contrast-enhanced ultrasound and/or colour duplex ultrasound for surveillance after endovascular abdominal aortic aneurysm repair: a systematic review and economic evaluation

Brazzelli

Hernández

Sharma

et al. 2018

Health Technol Assess

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Background Endovascular abdominal aortic aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) is less invasive than open surgery, but may be associated with important complications. Patients receiving EVAR require long-term surveillance to detect abnormalities and direct treatments. Computed tomography angiography (CTA) has been the most common imaging modality adopted for EVAR surveillance, but it is associated with repeated radiation exposure and the risk of contrast-related nephropathy. Colour duplex ultrasound (CDU) and, more recently, contrast-enhanced ultrasound (CEU) have been suggested as possible, safer, alternatives to CTA. Objectives To assess the clinical effectiveness and cost-effectiveness of imaging strategies, using either CDU or CEU alone or in conjunction with plain radiography, compared with CTA for EVAR surveillance. Data sources Major electronic databases were searched, including MEDLINE, EMBASE, Science Citation Index, Scopus’ Articles-in-Press, Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE) and NHS Economic Evaluation Database from 1996 onwards. We also searched for relevant ongoing studies and conference proceedings. The final searches were undertaken in September 2016. Methods We conducted a systematic review of randomised controlled trials and cohort studies of patients with AAAs who were receiving surveillance using CTA, CDU and CEU with or without plain radiography. Three reviewers were involved in the study selection, data extraction and risk-of-bias assessment. We developed a Markov model based on five surveillance strategies: (1) annual CTA; (2) annual CDU; (3) annual CEU; (4) CDU together with CTA at 1 year, followed by CDU on an annual basis; and (5) CEU together with CTA at 1 year, followed by CEU on an annual basis. All of these strategies also considered plain radiography on an annual basis. Results We identified two non-randomised comparative studies and 25 cohort studies of interventions, and nine systematic reviews of diagnostic accuracy. Overall, the proportion of patients who required reintervention ranged from 1.1% (mean follow-up of 24 months) to 23.8% (mean follow-up of 32 months). Reintervention was mainly required for patients with thrombosis and types I–III endoleaks. All-cause mortality ranged from 2.7% (mean follow-up of 24 months) to 42% (mean follow-up of 54.8 months). Aneurysm-related mortality occurred in < 1% of the participants. Strategies based on early and mid-term CTA and/or CDU and long-term CDU surveillance were broadly comparable with those based on a combination of CTA and CDU throughout the follow-up period in terms of clinical complications, reinterventions and mortality. The economic evaluation showed that a CDU-based strategy generated lower expected costs and higher quality-adjusted life-year (QALYs) than a CTA-based strategy and has a 63% probability of being cost-effective at a £30,000 willingness-to-pay-per-QALY threshold. A CEU-based strategy generated more QALYs, but at higher costs, and became cost-effective only for high-risk patient groups. Limitations Most studies were rated as being at a high or moderate risk of bias. No studies compared CDU with CEU. Substantial clinical heterogeneity precluded a formal synthesis of results. The economic model was hindered by a lack of suitable data. Conclusions Current surveillance practice is very heterogeneous. CDU may be a safe and cost-effective alternative to CTA, with CTA being reserved for abnormal/inconclusive CDU cases. Future work Research is needed to validate the safety of modified, more-targeted surveillance protocols based on the use of CDU and CEU. The role of radiography for surveillance after EVAR requires clarification. Study registration This study is registered as PROSPERO CRD42016036475. Funding The National Institute for Health Research Health Technology Assessment programme.

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Predictive Factors for Abdominal Aortic Aneurysm Shrinkage One Year after Successful Endovascular Aneurysm Repair

Shingaki

Morishita

Baba

et al. 2018

Annals of Vascular Surgery

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Aneurysm Sac Shrinkage after Endovascular Repair: Predictive Factors and Long-Term Follow-Up

Cited by 24 publications

References 22 publications

Late single-center outcome of the Talent Abdominal Stent Graft after a decade of follow-up

Late single-center outcome of the Talent Abdominal Stent Graft after a decade of follow-up

Contrast-enhanced ultrasound and/or colour duplex ultrasound for surveillance after endovascular abdominal aortic aneurysm repair: a systematic review and economic evaluation

Predictive Factors for Abdominal Aortic Aneurysm Shrinkage One Year after Successful Endovascular Aneurysm Repair

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