Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms

Elkouri, Stéphane; Gloviczki, Péter; McKusick, Michael A.; Panneton, Jean M.; Andrews, James C.; Bower, Thomas C.; Noel, Audra A.; Harmsen, William S.; Hoskin, Tanya L.; Cherry, Kenneth J.

doi:10.1016/j.jvs.2003.10.018

Cited by 147 publications

(89 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The advantage of EVAR over open AAA repair is that it is considerably less invasive and associated with a lower initial mortality rate and morbidity rates. [35][36][37] The main disadvantage of EVAR is that the repair is less stable with a substantially higher rate of late AAA-related complications including endoleak, graft displacement, stent fracture and even AAA rupture. 35,38 There have been a number of comparative studies between open AAA repair and EVAR.…”

Section: Open or Endovascular Repairmentioning

confidence: 99%

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Grant

Sperrin

Carlson

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

BackgroundAbdominal aortic aneurysm (AAA) repair aims to prevent premature death from AAA rupture. Elective repair is currently recommended when AAA diameter reaches 5.5 cm (men) and 5.0 cm (women). Applying population-based indications may not be appropriate for individual patient decisions, as the optimal indication is likely to differ between patients based on age and comorbidities.ObjectiveTo develop an Aneurysm Repair Decision Aid (ARDA) to indicate when elective AAA repair optimises survival for individual patients and to assess the cost-effectiveness and associated uncertainty of elective repair at the aneurysm diameter recommended by the ARDA compared with current practice.Data sourcesThe UK Vascular Governance North West and National Vascular Database provided individual patient data to develop predictive models for perioperative mortality and survival. Data from published literature were used to model AAA growth and risk of rupture. The cost-effectiveness analysis used data from published literature and from local and national databases.MethodsA combination of systematic review methods and clinical registries were used to provide data to populate models and inform the structure of the ARDA. Discrete event simulation (DES) was used to model the patient journey from diagnosis to death and synthesised data were used to estimate patient outcomes and costs for elective repair at alternative aneurysm diameters. Eight patient clinical scenarios (vignettes) were used as exemplars. The DES structure was validated by clinical and statistical experts. The economic evaluation estimated costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs) from the NHS, social care provider and patient perspective over a lifetime horizon. Cost-effectiveness acceptability analyses and probabilistic sensitivity analyses explored uncertainty in the data and the value for money of ARDA-based decisions. The ARDA outcome measures include perioperative mortality risk, annual risk of rupture, 1-, 5- and 10-year survival, postoperative long-term survival, median life expectancy and predicted time to current threshold for aneurysm repair. The primary economic measure was the ICER using the QALY as the measure of health benefit.ResultsThe analysis demonstrated it is feasible to build and run a complex clinical decision aid using DES. The model results support current guidelines for most vignettes but suggest that earlier repair may be effective in younger, fitter patients and ongoing surveillance may be effective in elderly patients with comorbidities. The model adds information to support decisions for patients with aneurysms outside current indications. The economic evaluation suggests that using the ARDA compared with current guidelines could be cost-effective but there is a high level of uncertainty.LimitationsLack of high-quality long-term data to populate all sections of the model meant that there is high uncertainty about the long-term clinical and economic consequences of repair. Modelling assumptions were necessary and the developed survival models require external validation.ConclusionsThe ARDA provides detailed information on the potential consequences of AAA repair or a decision not to repair that may be helpful to vascular surgeons and their patients in reaching informed decisions. Further research is required to reduce uncertainty about key data, including reintervention following AAA repair, and assess the acceptability and feasibility of the ARDA for use in routine clinical practice.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

Section: Open or Endovascular Repairmentioning

confidence: 99%

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Grant

Sperrin

Carlson

et al. 2015

Health Technology Assessment

View full text Add to dashboard Cite

show abstract

“…Some complications occur during or soon after the procedure, whereas others are only noticed during graft surveillance (Table 4). 34 A study by Ohki et al 35 analyzed complication and death rates within 30 days of EVAR and found the major complication and death rates were 17.6% and 8.5%, respectively. This remains an active and important area of EVAR research, and standards have been developed to facilitate reporting of endovascular abdominal aortic repair complications.…”

Section: Complicationsmentioning

confidence: 99%

Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms

et al. 2005

View full text Add to dashboard Cite

“…Current literature data indicate a clear trend toward reduction of mortality rate in patients from high perioperative risk groups due to progress in surgical technique and anesthesiology, associated with AAA treatment. surgical trauma, longer duration of the procedure and bigger blood loss (36). In 1996 Lawrence et al published data that indicated that pulmonary complication rate after abdominal surgical procedures was similar to cardiac complication rate (37).…”

Section: Risk Of Treatment Of Asymptomatic Aaamentioning

confidence: 99%

Evaluation of the Perioperative Risk Factors in Patients with the Abdominal Aorta Aneurysm - Literature Review

Mazurek

Nazarewski

Małkowski

2011

Polish Journal of Surgery

View full text Add to dashboard Cite

Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms

Cited by 147 publications

References 21 publications

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Calculating when elective abdominal aortic aneurysm repair improves survival for individual patients: development of the Aneurysm Repair Decision Aid and economic evaluation

Endovascular Repair of Abdominal and Thoracic Aortic Aneurysms

Evaluation of the Perioperative Risk Factors in Patients with the Abdominal Aorta Aneurysm - Literature Review

Contact Info

Product

Resources

About