Midterm Re-interventions and Survival After Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysm

Beek, S.C. van; Vahl, A.C.; Wisselink, Willem; Reekers, Jim A.; Legemate, Dink A.; Balm, Ron

doi:10.1016/j.ejvs.2015.02.015

Cited by 34 publications

(16 citation statements)

References 23 publications

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“…The authors thank Emma L. Briggs (Weill Cornell Medical College, New York, NY) for her valuable comments and editing, which greatly improved the manuscript. (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) .940…”

Section: Discussionmentioning

confidence: 99%

Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany

Behrendt

Sedrakyan

Rieß

et al. 2017

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany

Behrendt

Sedrakyan

Rieß

et al. 2017

Journal of Vascular Surgery

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“…According to Van Beck et al, the five years survival rates were similar 36% for EVAR and 38% for OAR (p = 0.83). The rates of freedom from re-intervention were 55% for endovascular procedure and 60% for open repair (p=0.96) but in the patients who survived their hospital stay the re-intervention rate was higher for EVAR than for OAR (p < 0.01) (34). Raats et al reported that the perioperative mortality was low and without significant difference for both methods, reaching 30% in the EVAR group compared to 26% after OAR (p = 0.64).…”

Section: In Europementioning

confidence: 97%

Endovascular Aneurysm Repair or Open Aneurysm Repair for the Treatment of Abdominal Aortic Aneurysm – The Latest Update

Kulig¹,

Lewandowski²,

Ziaja³

et al. 2016

Polish Journal of Surgery

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“…19 The only previous detailed reporting of midterm re-interventions comes from the Amsterdam cohort, which followed 467 patients (130 treated by EVAR, 337 by open repair). 3 The prospective data from the IMPROVE trial provide more cases with EVAR treated predominantly with bifurcated endografts, compared with the preferred use of aorto-uni-iliac endografts in the AJAX trial and Amsterdam study. 5 The finding from the Amsterdam cohort that graft infection was the commonest reason for mid-term re-intervention cannot be confirmed.…”

Section: Aneurysm Related Indicationmentioning

confidence: 99%

“…The most comprehensive study comes from the 467 patients with repair of ruptured AAA in the Amsterdam cohort from 2004 to 2011. 3 By 5 years 45% of the EVAR patients and 40% of the open repair patients had had at least one reintervention. The re-interventions in the primary admission and after discharge were described separately.…”

Section: Introductionmentioning

confidence: 99%

Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised Trial

Powell¹,

Sweeting²,

Ulug³

et al. 2018

Journal of Vascular Surgery

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WHAT THIS PAPER ADDSThe mid-term re-intervention rate after ruptured abdominal aortic aneurysm repair by endovascular or open repair appears to be twice as high as after elective repair. This suggests the need for bespoke surveillance protocols after rupture. Limb ischaemia is a frequent early reason and distal aneurysms a frequent later reason for re-intervention to indicate where quality improvement programmes might be directed. Limb amputation is uncommon but higher after open repair than after endovascular aneurysm repair.Objective/Background: The aim was to describe the re-interventions after endovascular and open repair of rupture, and investigate whether these were associated with aortic morphology. Methods: In total, 502 patients from the IMPROVE randomised trial (ISRCTN48334791) with repair of rupture were followed-up for re-interventions for at least 3 years. Pre-operative aortic morphology was assessed in a core laboratory. Re-interventions were described by time (0e90 days, 3 monthse3 years) as arterial or laparotomy related, respectively, and ranked for severity by surgeons and patients separately. Rare re-interventions to 1 year, were summarised across three ruptured abdominal aortic aneurysm trials (IMPROVE, AJAX, and ECAR) and odds ratios (OR) describing differences were pooled via meta-analysis. Results: Re-interventions were most common in the first 90 days. Overall rates were 186 and 226 per 100 person years for the endovascular strategy and open repair groups, respectively (p ¼ .20) but between 3 months and 3 years (mid-term) the rates had slowed to 9.5 and 6.0 re-interventions per 100 person years, respectively (p ¼ .090) and about one third of these were for a life threatening condition. In this latter, mid-term period, 42 of 313 remaining patients (13%) required at least one re-intervention, most commonly for endoleak or other endograft complication after treatment by endovascular aneurysm repair (EVAR) (21 of 38 re-interventions), whereas distal aneurysms were the commonest reason (four of 23) for re-interventions after treatment by open repair. Arterial re-interventions within 3 years were associated with increasing common iliac artery diameter (OR 1.48, 95% confidence interval [CI] 0.13e0.93; p ¼ .004). Amputation, rare but ranked as the worst reintervention by patients, was less common in the first year after treatment with EVAR (OR 0.2, 95% CI 0.05e0.88) from meta-analysis of three trials. Conclusion: The rate of mid-term re-interventions after rupture is high, more than double that after elective EVAR and open repair, suggesting the need for bespoke surveillance protocols. Amputations are much less common in patients treated by EVAR than in those treated by open repair.

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Midterm Re-interventions and Survival After Endovascular Versus Open Repair for Ruptured Abdominal Aortic Aneurysm

Abstract: Five years after the primary intervention, endovascular and open repair for ruptured abdominal aortic aneurysm resulted in similar re-intervention and survival rates. However, in patients who survived their hospital stay the re-intervention rate was higher for EVAR than for OR.

Cited by 34 publications

References 23 publications

Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany

Short-term and long-term results of endovascular and open repair of abdominal aortic aneurysms in Germany

Endovascular Aneurysm Repair or Open Aneurysm Repair for the Treatment of Abdominal Aortic Aneurysm – The Latest Update

Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised Trial

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