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dc.contributor.authorPowell, Janet T
dc.contributor.authorSweeting, Michael J
dc.contributor.authorUlug, Pinar
dc.contributor.authorThompson, Matthew M
dc.contributor.authorHinchliffe, Robert J
dc.contributor.authorIMPROVE Trial Investigators
dc.date.accessioned2018-05-25T14:01:36Z
dc.date.available2018-05-25T14:01:36Z
dc.date.issued2018-05
dc.identifier.issn1078-5884
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/276219
dc.description.abstractOBJECTIVE/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 (0-90 days, 3 months-3 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 = .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 = .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] 0.13-0.93; p = .004). Amputation, rare but ranked as the worst re-intervention by patients, was less common in the first year after treatment with EVAR (OR 0.2, 95% CI 0.05-0.88) 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.
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherElsevier BV
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectIMPROVE Trial Investigators
dc.subjectAorta, Abdominal
dc.subjectHumans
dc.subjectAortic Rupture
dc.subjectAortic Aneurysm, Abdominal
dc.subjectLaparotomy
dc.subjectAmputation
dc.subjectReoperation
dc.subjectFollow-Up Studies
dc.subjectNeeds Assessment
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectEndovascular Procedures
dc.subjectEndoleak
dc.titleEditor's Choice - Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised Trial.
dc.typeArticle
prism.endingPage632
prism.issueIdentifier5
prism.publicationDate2018
prism.publicationNameEur J Vasc Endovasc Surg
prism.startingPage625
prism.volume55
dc.identifier.doi10.17863/CAM.23499
dcterms.dateAccepted2018-01-29
rioxxterms.versionofrecord10.1016/j.ejvs.2018.01.028
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2018-05
dc.contributor.orcidSweeting, Michael [0000-0003-0980-8965]
dc.identifier.eissn1532-2165
rioxxterms.typeJournal Article/Review
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (14/179/01)
pubs.funder-project-idDepartment of Health (via National Institute for Health Research (NIHR)) (NIHR BTRU-2014-10024)
cam.issuedOnline2018-03
cam.orpheus.successThu Jan 30 12:59:40 GMT 2020 - The item has an open VoR version.
rioxxterms.freetoread.startdate2100-01-01


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Attribution-NonCommercial-NoDerivatives 4.0 International
Except where otherwise noted, this item's licence is described as Attribution-NonCommercial-NoDerivatives 4.0 International