International validation of a risk score for complications and reinterventions after endovascular aneurysm repair

Karthikesalingam, Alan; Vidal‐Diez, Alberto; Bruin, Jorg L. de; Thompson, Matt; Hinchliffe, Robert J.; Loftus, Ian; Holt, Peter

doi:10.1002/bjs.9758

Cited by 14 publications

(15 citation statements)

References 35 publications

(39 reference statements)

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“…20 A recent validation of their original study revealed a significant difference in freedom from endograft complications at 3 years. 21 Our study supports the notion that patients are at increased or decreased risk due to their individual anatomy. The low rates of implant-related and systemic complications in the lowscore ASG group suggest that these patients may not require a 6-month or even a 1-year follow-up.…”

Section: Discussionsupporting

confidence: 87%

Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality

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Ahanchi

Larion

et al. 2016

Journal of Vascular Surgery

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Section: Discussionsupporting

confidence: 87%

Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality

Best

Ahanchi

Larion

et al. 2016

Journal of Vascular Surgery

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“…8, Five secondary studies described external validation of risk scores for reintervention or aortic complications. 43,[46][47][48][49] The 29 primary studies reported 39 898 patients, with study midpoints ranging from 1998 to 2011. Predictors of aortic complications and reintervention were identified from preoperative, intraoperative, and postoperative EVAR data (Table 1).…”

Section: Results Of the Literature Searchmentioning

confidence: 99%

A Systematic Review of Predictors of Reintervention After EVAR: Guidance for Risk-Stratified Surveillance

Patel

Allen

Grima

et al. 2017

Vasc Endovascular Surg

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“…Five publications reporting data from the ENGAGE registry were identified in the literature [93][94][95][96][97] ( Table 10). The study by Tang et al, 93 which compared the 12 outcomes after repair of AAA with bifurcated versus aorto-uni-iliac configuration of the Endurant stent-graft, used data collected in the ENGAGE registry from March 2009 to August 2010.…”

Section: The Endurant Stent Graft Natural Selection Global Postmarketmentioning

confidence: 99%

“…The study by Karthikesalingam et al 95 used data from the ENGAGE registry on reintervention and engraft complications at 3 years to predict whether patients would be at a low risk or a high risk of complications after EVAR based on the international validated St George's Vascular Institute score. 95 Overall, there were Stokmans 2012 94 Tang (2013) 93Karthikesalingam 2015; 95 and Bastos Goncalves (2015) 97 Faure 2015 94 Tang (2013) 93Karthikesalingam (2015); 95 and Bastos Goncalves (2015) 97 Faure (2015) 96All-cause mortality, n (%) 16 1.342 8.414 1.328 8.6Procedure-related mortality (up to 30 days)…”

Section: The Endurant Stent Graft Natural Selection Global Postmarketmentioning

confidence: 99%

“…3/325 (0.9) 4/325 1.2Aneurysm-related mortality (up to 30 days) 94 Tang (2013) 93Karthikesalingam (2015); 95 and Bastos Goncalves (2015) 97 Faure 2015 19.6% and 0.4% of participants, respectively). Aneurysm expansion that was greater than 5 mm was observed in 90.1 participants per 100 patient-years of follow-up (affecting 14.8% of participants).…”

Section: The Endurant Stent Graft Natural Selection Global Postmarketmentioning

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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International validation of a risk score for complications and reinterventions after endovascular aneurysm repair

Abstract: This study has provided international validation of a morphological risk score that predicts mid-term reinterventions and endograft complications. The results may enable risk-stratified surveillance after EVAR.

Cited by 14 publications

References 35 publications

Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality

Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality

A Systematic Review of Predictors of Reintervention After EVAR: Guidance for Risk-Stratified Surveillance

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

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