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Secondary intervention and surveillance after abdominal aortic aneurysm repair: retrospective cohort study
| Resumo: | Introduction: The early survival benefits of endovascular aortic aneurysm repair (EVAR) seem to decrease over time and late aneurysm-related mortality might be even higher than open repair. The objectives of this study are to determine the rate of secondary intervention (SI) and compliance with surveillance following EVAR. Methods: This is a retrospective cohort study of consecutive patients submitted to elective EVAR, between February/2009 and May/2019 in a single institution. Symptomatic or ruptured AAA, mycotic aneurysms, isolated iliac aneurysms and complex abdominal aortic repairs were excluded. The primary outcomes were freedom from SI and compliance with follow-up, defined as surveillance imaging performed within a periodicity no longer than 18 months. Results: A total of 214 patients underwent EVAR, 97% were male with 72±10 years old. After a median follow up of 44 months (95% Confidence Interval [95%CI] 39-49), there were 42 SIs performed in 25 patients. Freedom from SI was 96.3±1.3% at 30 days and 93.6±1.7%, 90.3±2.2% and 85.9±3.0 at 1, 3 and 5 years. Endoleaks were the main cause of SI after EVAR, namely type 1 and type 2. From all SIs, 33.3% (14/42) were due to symptomatic complications. At 5 years, aneurysm sac regression was lower in the SI group (85.1±9.7% vs 55.6±5.3%, P=0.017), but patient survival was identical (84.4±7.2 vs 76.7±4.1, P=0.386). The first surveillance imaging was performed during the first 30 days in 69 patients (36.3%). Compliance with surveillance was 80.4±2.9% at 1 year, and 37.7±5.4% at 5 years. Conclusions: SIs are associated with a lower aneurysm sac regression and are essential for EVAR to achieve its full potential. Most SIs are due to image-detected asymptomatic complications, however, compliance with surveillance decrease with longer follow-up times. The importance of this finding in long-term outcomes of EVAR deserves further investigation. |
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| Assunto: | Medicina clínica Clinical medicine |
| País: | Portugal |
| Tipo de documento: | dissertação de mestrado |
| Tipo de acesso: | Restrito |
| Instituição associada: | Repositório Aberto da Universidade do Porto |
| Idioma: | inglês |
| Origem: | Repositório Aberto da Universidade do Porto |
| _version_ | 1850560636788932608 |
|---|---|
| conditionsOfAccess_str | restricted access |
| country_str | PT |
| description | Introduction: The early survival benefits of endovascular aortic aneurysm repair (EVAR) seem to decrease over time and late aneurysm-related mortality might be even higher than open repair. The objectives of this study are to determine the rate of secondary intervention (SI) and compliance with surveillance following EVAR. Methods: This is a retrospective cohort study of consecutive patients submitted to elective EVAR, between February/2009 and May/2019 in a single institution. Symptomatic or ruptured AAA, mycotic aneurysms, isolated iliac aneurysms and complex abdominal aortic repairs were excluded. The primary outcomes were freedom from SI and compliance with follow-up, defined as surveillance imaging performed within a periodicity no longer than 18 months. Results: A total of 214 patients underwent EVAR, 97% were male with 72±10 years old. After a median follow up of 44 months (95% Confidence Interval [95%CI] 39-49), there were 42 SIs performed in 25 patients. Freedom from SI was 96.3±1.3% at 30 days and 93.6±1.7%, 90.3±2.2% and 85.9±3.0 at 1, 3 and 5 years. Endoleaks were the main cause of SI after EVAR, namely type 1 and type 2. From all SIs, 33.3% (14/42) were due to symptomatic complications. At 5 years, aneurysm sac regression was lower in the SI group (85.1±9.7% vs 55.6±5.3%, P=0.017), but patient survival was identical (84.4±7.2 vs 76.7±4.1, P=0.386). The first surveillance imaging was performed during the first 30 days in 69 patients (36.3%). Compliance with surveillance was 80.4±2.9% at 1 year, and 37.7±5.4% at 5 years. Conclusions: SIs are associated with a lower aneurysm sac regression and are essential for EVAR to achieve its full potential. Most SIs are due to image-detected asymptomatic complications, however, compliance with surveillance decrease with longer follow-up times. The importance of this finding in long-term outcomes of EVAR deserves further investigation. |
| documentTypeURL_str | http://purl.org/coar/resource_type/c_bdcc |
| documentType_str | master thesis |
| id | 4fb6f2a3-e8ee-4af5-996d-4ada30c0d6ad |
| identifierHandle_str | https://hdl.handle.net/10216/142226 |
| language | eng |
| relatedInstitutions_str_mv | Repositório Aberto da Universidade do Porto |
| resourceName_str | Repositório Aberto da Universidade do Porto |
| spellingShingle | Secondary intervention and surveillance after abdominal aortic aneurysm repair: retrospective cohort study Medicina clínica Clinical medicine |
| title | Secondary intervention and surveillance after abdominal aortic aneurysm repair: retrospective cohort study |
| topic | Medicina clínica Clinical medicine |