Evaluation of Potential Outcome Predictors in Type II Endoleak: A Retrospective Study With CT Angiography Feature Analysis

Keedy, Alexander W.; Yeh, Benjamin M.; Kohr, Jennifer R.; Hiramoto, Jade S.; Schneider, Darren B.; Breiman, Richard S.

doi:10.2214/ajr.10.4566

Cited by 29 publications

(37 citation statements)

References 27 publications

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“…This study is not directly comparable to the investigations of Keedy et al (12) and Timaran et al (13). The main difference is the choice of study endpoints.…”

Section: Discussioncontrasting

confidence: 74%

“…The main difference is the choice of study endpoints. Keedy et al (12) used intervention of type II endoleak and Timaran et al (13) the maximum aneurysm diameter as study endpoints. In contrast, we used the aneurysm volume.…”

Section: Discussionmentioning

confidence: 99%

“…Nearly half of them resolve spontaneously within 6 months (transient), whereas a persistent endoleak may be associated with further substantial aneurysm sac enlargement (2,3,11). Little is known about the factors that help predict the natural course of an early type II endoleak (12,13). It would be beneficial to understand which features on the first postoperative contrast material-enhanced computed tomographic (CT) scan are associated with significant aneurysm sac enlargement during follow-up.…”

Section: Implication For Patient Carementioning

confidence: 99%

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CT Features of Early Type II Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms Help Predict Aneurysm Sac Enlargement

Müller-Wille¹,

Schötz²,

Zeman³

et al. 2015

Radiology

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“…This study is not directly comparable to the investigations of Keedy et al (12) and Timaran et al (13). The main difference is the choice of study endpoints.…”

Section: Discussioncontrasting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Implication For Patient Carementioning

confidence: 99%

See 1 more Smart Citation

CT Features of Early Type II Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms Help Predict Aneurysm Sac Enlargement

Müller-Wille¹,

Schötz²,

Zeman³

et al. 2015

Radiology

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“…155 Additionally, management of type II endoleak (preoperative vs. postoperative vs. expectant management) provided a summary of the known position in 2009 156 and a retrospective study with CT angiography evaluating the potential outcome of predictors in type II endoleak was also available in 2011. 157 Type II endoleaks are a common complication of endovascular repair of AAA (EVAR). The sensitivity and specificity of the detection depends on the imaging modalities used for postoperative EVAR surveillance, with magnetic resonance imaging being described as the most sensitive method.…”

Section: Discussionmentioning

confidence: 99%

The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis

Patel

Powell

Sweeting

et al. 2018

Health Technol Assess

101

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BackgroundShort-term survival benefits of endovascular aneurysm repair (EVAR) compared with open repair (OR) of intact abdominal aortic aneurysms have been shown in randomised trials, but this early survival benefit is soon lost. Survival benefit of EVAR was unclear at follow-up to 10 years.ObjectiveTo assess the long-term efficacy of EVAR against OR in patients deemed fit and suitable for both procedures (EVAR trial 1; EVAR-1); and against no intervention in patients unfit for OR (EVAR trial 2; EVAR-2). To appraise the long-term significance of type II endoleak and define criteria for intervention.DesignTwo national, multicentre randomised controlled trials: EVAR-1 and EVAR-2.SettingPatients were recruited from 37 hospitals in the UK between 1 September 1999 and 31 August 2004.ParticipantsMen and women aged ≥ 60 years with an aneurysm of ≥ 5.5 cm (as identified by computed tomography scanning), anatomically suitable and fit for OR were randomly assigned 1 : 1 to either EVAR (n = 626) or OR (n = 626) in EVAR-1 using computer-generated sequences at the trial hub. Patients considered unfit were randomly assigned to EVAR (n = 197) or no intervention (n = 207) in EVAR-2. There was no blinding.InterventionsEVAR, OR or no intervention.Main outcome measuresThe primary end points were total and aneurysm-related mortality until mid-2015 for both trials. Secondary outcomes for EVAR-1 were reinterventions, costs and cost-effectiveness.ResultsIn EVAR-1, over a mean of 12.7 years (standard deviation 1.5 years; maximum 15.8 years), we recorded 9.3 deaths per 100 person-years in the EVAR group and 8.9 deaths per 100 person-years in the OR group [adjusted hazard ratio (HR) 1.11, 95% confidence interval (CI) 0.97 to 1.27;p = 0.14]. At 0–6 months after randomisation, patients in the EVAR group had a lower mortality (adjusted HR 0.61, 95% CI 0.37 to 1.02 for total mortality; HR 0.47, 95% CI 0.23 to 0.93 for aneurysm-related mortality;p = 0.031), but beyond 8 years of follow-up patients in the OR group had a significantly lower mortality (adjusted HR 1.25, 95% CI 1.00 to 1.56,p = 0.048 for total mortality; HR 5.82, 95% CI 1.64 to 20.65,p = 0.0064 for aneurysm-related mortality). The increased aneurysm-related mortality in the EVAR group after 8 years was mainly attributable to secondary aneurysm sac rupture, with increased cancer mortality also observed in the EVAR group. Overall, aneurysm reintervention rates were higher in the EVAR group than in the OR group, 4.1 and 1.7 per 100 person-years, respectively (p < 0.001), with reinterventions occurring throughout follow-up. The mean difference in costs over 14 years was £3798 (95% CI £2338 to £5258). Economic modelling based on the outcomes of the EVAR-1 trial showed that the cost per quality-adjusted life-year gained over the patient’s lifetime exceeds conventional thresholds used in the UK. In EVAR-2, patients died at the same rate in both groups, but there was suggestion of lower aneurysm mortality in those who actually underwent EVAR. Type II endoleak itself is not associated with a higher rate of mortality.LimitationsDevices used were implanted between 1999 and 2004. Newer devices might have better results. Later follow-up imaging declined, particularly for OR patients. Methodology to capture reinterventions changed mainly to record linkage through the Hospital Episode Statistics administrative data set from 2009.ConclusionsEVAR has an early survival benefit but an inferior late survival benefit compared with OR, which needs to be addressed by lifelong surveillance of EVAR and reintervention if necessary. EVAR does not prolong life in patients unfit for OR. Type II endoleak alone is relatively benign.Future workTo find easier ways to monitor sac expansion to trigger timely reintervention.Trial registrationCurrent Controlled Trials ISRCTN55703451.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and the results will be published in full inHealth Technology Assessment; Vol. 22, No. 5. See the NIHR Journals Library website for further project information.

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“…En el momento actual, se tratan todas aquellas endofugas tipo 2 con crecimiento superior a los 10 mm, o con aumentos rápidos del tamaño del saco (5 mm en un año), de acuerdo a las recomendaciones publicadas 8 . Asimismo, no se realizó volumetría del saco aneurismático ni de la cavidad de cada endofuga, variables que sí han mostrado relevancia en otros trabajos 35 .…”

Section: Discusión Y Conclusionesunclassified

Endofugas tipo 2 en una población tratada con endoprótesis Gore® Excluder: incidencia, persistencia y crecimiento del saco aneurismático

et al. 2015

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Recibido el 5 de marzo de 2014; aceptado el 20 de enero de 2015 Disponible en Internet el 26 de febrero de 2015 PALABRAS CLAVEEndofuga; Procedimientos endovasculares; Aneurisma de aorta abdominal (MeSH); Crecimiento del saco aneurismático ResumenIntroducción: La endofuga tipo 2 (EF2) es la complicación más frecuente tras EVAR, con una tasa de crecimiento del saco variable y un tratamiento de resultados poco efectivos. Se pretende analizar la incidencia de EF2, su persistencia y evolución en una población homogénea, buscando variables predictoras de crecimiento del saco. Material y métodos: Setenta EF2 (32,2%) detectadas en 217 EVAR aortoilíacos tratados con GORE ® Excluder entre 2003 y 2011. Seguimiento clínico y con angiotomografía computarizada (media 32,5 meses). Análisis univariante de datos recogidos de forma prospectiva. Función de supervivencia de Kaplan-Meier y regresión de Cox. Resultados: Un 90% de varones con edad media 75,5 ± 8 años y diámetro aórtico 59,6 ± 10 mm. El vaso aferente más frecuente fue una arteria lumbar (n = 42), con un 30% de endofugas complejas (n = 21). Veinticinco endofugas fueron transitorias (35,7%) y 45 persistentes, grupo este último con mayor número de mujeres (p = 0,044) y de colaterales aferentes al saco (1,5 ± 0,7 vs. 1,2 ± 0,4, p = 0,022). Crecimiento > 5 mm en un 38,6% de casos (mediana 8,5 mm, rango 5-24); once se trataron con embolización (éxito 63,6%). Las endofugas complejas no incrementaron el riesgo. El único predictor independiente de crecimiento en la regresión de Cox fue la edad (HR 2,71 IC 95% 1,01-7,19 p = 0,046). Conclusiones: Las EF2 constituyen una complicación frecuente y sin factores predictores sóli-dos que permitan estratificar el riesgo de crecimiento del saco, por lo que es necesario un seguimiento exhaustivo.

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Evaluation of Potential Outcome Predictors in Type II Endoleak: A Retrospective Study With CT Angiography Feature Analysis

Abstract: There are identifiable CT features associated with the clinical outcome of patients with type II endoleak that have moderate predictive capabilities.

Cited by 29 publications

References 27 publications

CT Features of Early Type II Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms Help Predict Aneurysm Sac Enlargement

CT Features of Early Type II Endoleaks after Endovascular Repair of Abdominal Aortic Aneurysms Help Predict Aneurysm Sac Enlargement

The UK EndoVascular Aneurysm Repair (EVAR) randomised controlled trials: long-term follow-up and cost-effectiveness analysis

Endofugas tipo 2 en una población tratada con endoprótesis Gore® Excluder: incidencia, persistencia y crecimiento del saco aneurismático

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