uu.seUppsala University Publications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Early sac shrinkage predicts a low risk of late complications after endovascular aortic aneurysm repair
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
Show others and affiliations
2014 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 101, no 7, 802-810 p.Article in journal (Refereed) Published
Abstract [en]

Background: Aneurysm shrinkage has been proposed as a marker of successful endovascular aneurysm repair (EVAR). Patients with early postoperative shrinkage may experience fewer subsequent complications, and consequently require less intensive surveillance. Methods: Patients undergoing EVAR from 2000 to 2011 at three vascular centres (in 2 countries), who had two imaging examinations (postoperative and after 6-18 months), were included. Maximum diameter, complications and secondary interventions during follow-up were registered. Patients were categorized according to early sac dynamics. The primary endpoint was freedom from late complications. Secondary endpoints were freedom from secondary intervention, postimplant rupture and direct (type I/III) endoleaks. Results: Some 597 EVARs (71.1 per cent of all EVARs) were included. No shrinkage was observed in 284 patients (47.6 per cent), moderate shrinkage (5-9mm) in 142 (23.8 per cent) and major shrinkage (at least 10mm) in 171 patients (28.6 per cent). Four years after the index imaging, the rate of freedom from complications was 84.3 (95 per cent confidence interval 78.7 to 89.8), 88.1 (80.6 to 95.5) and 94.4 (90.1 to 98.7) per cent respectively. No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3.11; P < 0.001). Moderate compared with major shrinkage (HR 2.10; P = 0.022), early postoperative complications (HR 3.34; P < 0.001) and increasing abdominal aortic aneurysm baseline diameter (HR 1.02; P = 0.001) were also risk factors for late complications. Freedom from secondary interventions and direct endoleaks was greater for patients with major sac shrinkage. Conclusion: Early change in aneurysm sac diameter is a strong predictor of late complications after EVAR. Patients with major sac shrinkage have a very low risk of complications for up to 5 years. This parameter may be used to tailor postoperative surveillance.

Place, publisher, year, edition, pages
2014. Vol. 101, no 7, 802-810 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-228003DOI: 10.1002/bjs.9516ISI: 000335648000010OAI: oai:DiVA.org:uu-228003DiVA: diva2:732019
Available from: 2014-07-03 Created: 2014-07-02 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Endovascular aortic aneurysm repair: Aspects of follow-up and complications
Open this publication in new window or tab >>Endovascular aortic aneurysm repair: Aspects of follow-up and complications
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Endovascular aortic aneurysm repair (EVAR) is the procedure of choice in most patients with abdominal aortic aneurysm. The drawbacks of EVAR are a higher rate of complications and frequent need for reinterventions, requiring regular postoperative follow-up. Non-stratified follow-up may have a deleterious effect on patients and the health care system. The aim of this thesis is to develop strategies that can stratify the EVAR follow-up programme according to an individual patient´s risk profile.

Study I, an international multicentre study of all abdominal aortic aneurysm (AAA) patients with EVAR in three centres (2000 to 2011) demonstrated a lower rate of late complications and reinterventions in patients with sac shrinkage during the first postoperative year, compared to the non-shrinkage group.

Study II, an international multicentre study of patients treated for a ruptured aortic aneurysm with EVAR in three centres (2000 to 2012) demonstrated that ruptured EVAR (rEVAR) in patients with hostile anatomy is associated with a high rate of graft-related complications, reinterventions and increased overall mortality.

Study III, a two-centre cohort study of 326 patients with EVAR (2001 to 2012), with first postoperative computerised tomographic angiography (CTA) within one year of the operation. Patients with adequate proximal and distal sealing zones and no endoleak in the first postoperative CTA had significantly lower risk for AAA-related complications and reinterventions up to five years postoperatively.

Study IV, studied all complications and reinterventions in a two-centre cohort study of all EVAR patients (1998 to 2012), One-fourth of the patients in the study developed complications during a mean follow-up of five years. Most complications were asymptomatic imaging-detected. Ultrasound could detect most of the clinically significant complications.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. 89 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1402
Keyword
abdominal aortic aneurysm, EVAR, rEVAR surveillance
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-334369 (URN)978-91-513-0167-9 (ISBN)
Public defence
2018-01-19, Gustavianum, Akademigatan 3, 753 10 Uppsala, Sverige, Uppsala, 13:15 (English)
Opponent
Supervisors
Available from: 2017-12-22 Created: 2017-11-23 Last updated: 2017-12-22

Open Access in DiVA

fulltext(144 kB)191 downloads
File information
File name FULLTEXT01.pdfFile size 144 kBChecksum SHA-512
8a5249d1438e292deae9285adde360a178c2fe655d341b24b32efdb16bcb3f4370be1a5ec6821ea2aff40e7de40e100365809965dd6f82d707a8975b26c88d80
Type fulltextMimetype application/pdf

Other links

Publisher's full text

Authority records BETA

Baderkhan, HassanWanhainen, AndersBjörck, MartinMani, Kevin

Search in DiVA

By author/editor
Baderkhan, HassanWanhainen, AndersBjörck, MartinMani, Kevin
By organisation
Vascular Surgery
In the same journal
British Journal of Surgery
Surgery

Search outside of DiVA

GoogleGoogle Scholar
Total: 191 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 756 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf