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dc.contributor.authorGrootes, Isabelle
dc.contributor.authorBarrett, Jessica
dc.contributor.authorUlug, Pinar
dc.contributor.authorRohlffs, Fiona
dc.contributor.authorLaukontaus, Sani
dc.contributor.authorTulamo, Riikka
dc.contributor.authorVenermo, Maarit
dc.contributor.authorGreenhalgh, Roger
dc.contributor.authorSweeting, Michael
dc.date.accessioned2019-02-26T18:36:43Z
dc.date.available2019-02-26T18:36:43Z
dc.date.issued2018-09
dc.identifier.issn1365-2168
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/290006
dc.description.abstractClinical and imaging surveillance practices following endovascular aneurysm repair (EVAR) for intact abdominal aortic aneurysm (AAA) vary considerably and compliance with recommended lifelong surveillance is poor. This study developed a dynamic prognostic model to enable stratification of patients at risk of future secondary rupture or rupture preventing re-intervention (RPR) to enable the development of personalised surveillance intervals. Baseline data and repeat measurements of post-operative aneurysm sac diameter from the EVAR-1 and EVAR-2 trials were used to develop the model with external validation in a cohort from Helsinki. Longitudinal mixed-effects models were fitted to trajectories of sac diameter and model-predicted sac diameter and rate of growth were used in prognostic Cox proportional hazards models. 785 patients from the EVAR trials were included of which 155 (20%) suffered at least one rupture or RPR during follow-up. An increased risk was associated with pre-operative AAA size, rate of sac growth, and the number of previously detected complications. A prognostic model using only predicted sac growth had good discrimination at 2-years (C-index = 0.68), 3-years (C-index= 0.72) and 5-years (C-index= 0.75) post-operation and had excellent external validation (C-indices 0.76 to 0.79). After 5-years post-operation, growth rates above 1mm/year had a sensitivity of over 80% and specificity over 50% in identifying events occurring within 2 years. Secondary sac growth is an important predictor of rupture or RPR. A dynamic prognostic model has the potential to tailor surveillance by identifying a large proportion of patients who may require less intensive follow-up.
dc.publisherWiley-Blackwell
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.titlePredicting risk of rupture and rupture-preventing re-interventions utilising repeated measures on aneurysm sac diameter following endovascular abdominal aortic aneurysm repair
dc.typeArticle
prism.endingPage1304
prism.issueIdentifier10
prism.publicationNameBritish Journal of Surgery
prism.startingPage1294
prism.volume105
dc.identifier.doi10.17863/CAM.37233
dcterms.dateAccepted2018-06-30
rioxxterms.versionofrecord10.1002/bjs.10964
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
rioxxterms.licenseref.startdate2018-06-30
dc.contributor.orcidBarrett, Jessica [0000-0003-1889-9803]
dc.contributor.orcidSweeting, Michael [0000-0003-0980-8965]
dc.identifier.eissn1365-2168
dc.publisher.urlhttps://onlinelibrary.wiley.com/doi/abs/10.1002/bjs.10964
rioxxterms.typeJournal Article/Review
pubs.funder-project-idMedical Research Council (MR/K014811/1)
pubs.funder-project-idMRC (MR/L501566/1)
pubs.funder-project-idMRC (unknown)
pubs.funder-project-idMedical Research Council (MR/L003120/1)
pubs.funder-project-idMedical Research Council (G0701619)
pubs.funder-project-idBritish Heart Foundation (None)
cam.issuedOnline2018-08-07
dc.identifier.urlhttps://onlinelibrary.wiley.com/doi/abs/10.1002/bjs.10964


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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