Editor's Choice – The Implications of Non-compliance to Endovascular Aneurysm Repair Surveillance: A Systematic Review and Meta-analysis

Grima, Matthew Joe; Boufi, Mourad; Law, Martin; Jackson, Dan; Stenson, Kristina; Patterson, Benjamin O.; Loftus, Ian; Thompson, Matt; Karthikesalingam, Alan; Holt, Peter

doi:10.1016/j.ejvs.2017.11.030

Cited by 38 publications

(21 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This systematic review showed that compliance to post-EVAR imaging surveillance appears not to protect against secondary rupture or mortality compared to partial/noncompliance during a median of 31.7 months’ follow-up even though more reinterventions were performed in the compliance subgroup. The conclusions of this meta-analysis are in agreement with the publication by Grima et al 22…”

Section: Discussionsupporting

confidence: 92%

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

et al. 2019

View full text Add to dashboard Cite

Purpose: To study the effects of imaging surveillance after endovascular aortic repair (EVAR) on reintervention and mortality. Materials and Methods: A systematic review was conducted comparing complication rates in EVAR patients compliant with the imaging surveillance protocol vs partially or noncompliant patients. Two authors independently selected articles and performed quality assessment and data extraction. Risk differences for reintervention and mortality between compliant and partially/noncompliant patients were meta-analyzed. The pooled risk difference (RD) is reported with the 95% confidence interval (CI). The review protocol is registered at Prospero (CRD42017080494). Results: A total of 11 cohort studies involving 21,838 patients were included. Studies differed in imaging, their surveillance protocols, and definitions of compliance subgroups. Median follow-up was 31.7 months (interquartile range 29.8, 49.3). The overall reintervention rate was 5%, while the overall mortality was 31%. The RD for the reintervention rate was 4% (95% CI 1% to 7%) in favor of partial/noncompliance [number needed to harm 25 (95% CI 14 to 100)], while mortality showed a nonsignificant RD of 12% (95% CI −2% to 26%) in favor of partial/noncompliance. Two studies reported that 41% to 53% of reinterventions were performed for complications detected through imaging surveillance; the other events were detected through patient symptoms. Conclusion: Patients who are compliant with imaging surveillance appear to undergo more reinterventions than those who are partially or noncompliant. However, imaging surveillance does not seem to protect against mortality. This suggests that the recommended yearly imaging surveillance may not be beneficial for all EVAR patients.

show abstract

Section: Discussionsupporting

confidence: 92%

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…4 This in itself may explain why, despite the fact that compliant patients were subject to more reinterventions, the authors observed no survival benefit to compliance. This finding is in line with the review by Grima et al 5 It is noteworthy, however, that the median follow-up was <3 years.…”

supporting

confidence: 92%

Commentary: Surveillance After EVAR: Still Room for Debate

Boufi

Ozdemir

2019

J Endovasc Ther

Self Cite

View full text Add to dashboard Cite

“…A possible explanation given by the authors is that patients who were asymptomatic and potentially healthier were less likely to attend surveillance, which may result in the trend of better survival rates in non-compliant patients and more complications in the compliant group. 22 An interesting finding of the current report is the fact that patients in the post-EVAR group presented hemodynamically more stable at the time of rupture compared to those with primary rAAAs. This observation may not be surprising taking into account that the pressurization of the aneurysmal sac is significantly reduced after the implantation of an endograft compared to the native aneurysmal aorta, even in the presence of an endoleak.…”

Section: Discussionmentioning

confidence: 54%

Does a previous aortic endograft confer any protective effect during abdominal aortic aneurysm rupture? Systematic review and meta-analysis of comparative studies

et al. 2020

View full text Add to dashboard Cite

Objectives Whether prior endovascular aneurysm repair confers a protective effect in patients with ruptured abdominal aortic aneurysm (rAAA) is not known. We aimed to systematically review and compare the outcomes of rAAA in patients with and without prior endovascular aneurysm repair. Methods We performed a systematic review that conformed to the Preferred Reporting Items for Systematic Reviews and Meta-analysis. We selected studies comparing the outcomes in patients with rAAA after prior endovascular aneurysm repair (group 1) and those with de novo rAAAs (group 2). We conducted a proportion meta-analysis of perioperative mortality and obtained summary estimates of odds ratios (ORs) and 95% confidence intervals (CIs) using random-effects models. Results We included four studies (retrospective observational studies) in quantitative synthesis reporting a total of 719 patients (group 1 (89) group 2 (630)). The perioperative mortality in groups 1 and 2 was 30.4% and 41%, respectively, and there was no statistical significant difference between the groups (OR 0.66, 95% CI 0.30–1.43, P = 0.29, I2=58%). However, patients presenting with rAAA following previous endovascular aneurysm repair were more hemodynamically stable (OR 0.33, 95% CI 0.12–0.90, P = 0.03, I2=74%). The choice between endovascular or open surgery treatment in group 1 did not affect the perioperative mortality (OR 1.12, 95% CI 0.41–3.04 P = 0.82, I2=0%). Endoleak types I and III were the main causes of rAAA in group 1. Conclusions Perioperative mortality was similar for rAAA either de novo or after prior endovascular aneurysm repair. However, ruptures in patients with prior endovascular aneurysm repair presented hemodynamically more stable.

show abstract

Editor's Choice – The Implications of Non-compliance to Endovascular Aneurysm Repair Surveillance: A Systematic Review and Meta-analysis

Abstract: This systematic review and meta-analysis suggests that patients compliant with EVAR surveillance programmes may have an increased re-intervention rate but do not appear to have better survival rates than non-compliant patients.

Cited by 38 publications

References 48 publications

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

Commentary: Surveillance After EVAR: Still Room for Debate

Does a previous aortic endograft confer any protective effect during abdominal aortic aneurysm rupture? Systematic review and meta-analysis of comparative studies

Contact Info

Product

Resources

About