Predicting risk of rupture and rupture-preventing re-interventions utilising repeated measures on aneurysm sac diameter following endovascular abdominal aortic aneurysm repair

Simple item page
cam.issuedOnline2018-08-07
dc.contributor.authorGrootes, I
dc.contributor.authorBarrett, Jessica K
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 J
dc.contributor.orcidBarrett, Jessica [0000-0003-1889-9803]
dc.contributor.orcidSweeting, Michael [0000-0003-0980-8965]
dc.date.accessioned2019-02-26T18:36:43Z
dc.date.available2019-02-26T18:36:43Z
dc.date.issued2018-09
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.identifier.doi10.17863/CAM.37233
dc.identifier.eissn1365-2168
dc.identifier.issn1365-2168
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/290006
dc.publisherWiley-Blackwell
dc.publisher.urlhttps://onlinelibrary.wiley.com/doi/abs/10.1002/bjs.10964
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectAdult
dc.subjectAged
dc.subjectAged, 80 and over
dc.subjectAortic Aneurysm, Abdominal
dc.subjectAortic Rupture
dc.subjectEndovascular Procedures
dc.subjectFemale
dc.subjectFollow-Up Studies
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectModels, Statistical
dc.subjectPostoperative Complications
dc.subjectPrognosis
dc.subjectProportional Hazards Models
dc.subjectReoperation
dc.subjectRetrospective Studies
dc.subjectRisk Assessment
dc.subjectRisk Factors
dc.subjectSensitivity and Specificity
dc.subjectTreatment Outcome
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
dcterms.dateAccepted2018-06-30
prism.endingPage1304
prism.issueIdentifier10
prism.publicationNameBritish Journal of Surgery
prism.startingPage1294
prism.volume105
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)
rioxxterms.licenseref.startdate2018-06-30
rioxxterms.licenseref.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
rioxxterms.typeJournal Article/Review
rioxxterms.versionVoR
rioxxterms.versionofrecord10.1002/bjs.10964
Files
Original bundle
Now showing 1 - 2 of 2
Thumbnail Image
Name:
Grootes_et_al-2018-British_Journal_of_Surgery.pdf
Size:
357.94 KB
Format:
Adobe Portable Document Format
Description:
Published version
Licence
https://creativecommons.org/licenses/by-nc-nd/4.0/
Download
Thumbnail Image
Name:
Grootes_et_al-2018-British_Journal_of_Surgery.pdf
Size:
357.71 KB
Format:
Adobe Portable Document Format
Description:
Published version
Licence
https://creativecommons.org/licenses/by-nc-nd/4.0/
Download
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
DepositLicenceAgreement.pdf
Size:
417.78 KB
Format:
Adobe Portable Document Format
Download
Collections
Cambridge University Research Outputs