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Editor's Choice – Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised Trial

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Editor's Choice – Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm : A Report From the IMPROVE Randomised Trial. / IMPROVE Trial Investigators.

In: European Journal of Vascular and Endovascular Surgery, Vol. 55, No. 5, 05.2018, p. 625-632.

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IMPROVE Trial Investigators 2018, 'Editor's Choice – Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised Trial', European Journal of Vascular and Endovascular Surgery, vol. 55, no. 5, pp. 625-632. https://doi.org/10.1016/j.ejvs.2018.01.028

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IMPROVE Trial Investigators. / Editor's Choice – Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm : A Report From the IMPROVE Randomised Trial. In: European Journal of Vascular and Endovascular Surgery. 2018 ; Vol. 55, No. 5. pp. 625-632.

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@article{299414af9cb843f1aa88703276b99ebc,
title = "Editor's Choice – Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised Trial",
abstract = "Objective/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.",
keywords = "abdominal aortic aneurysm, rupture, re-intervention, morphology",
author = "{IMPROVE Trial Investigators} and Powell, {Janet T.} and Sweeting, {Michael J.} and Pinar Ulug and Thompson, {Matthew M.} and Hinchliffe, {Robert J.}",
year = "2018",
month = "5",
doi = "10.1016/j.ejvs.2018.01.028",
language = "English",
volume = "55",
pages = "625--632",
journal = "European Journal of Vascular and Endovascular Surgery",
issn = "1078-5884",
publisher = "W.B. Saunders",
number = "5",

}

RIS - suitable for import to EndNote

TY - JOUR

T1 - Editor's Choice – Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm

T2 - A Report From the IMPROVE Randomised Trial

AU - IMPROVE Trial Investigators

AU - Powell, Janet T.

AU - Sweeting, Michael J.

AU - Ulug, Pinar

AU - Thompson, Matthew M.

AU - Hinchliffe, Robert J.

PY - 2018/5

Y1 - 2018/5

N2 - Objective/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.

AB - Objective/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.

KW - abdominal aortic aneurysm

KW - rupture

KW - re-intervention

KW - morphology

UR - http://www.scopus.com/inward/record.url?scp=85042559802&partnerID=8YFLogxK

U2 - 10.1016/j.ejvs.2018.01.028

DO - 10.1016/j.ejvs.2018.01.028

M3 - Article

VL - 55

SP - 625

EP - 632

JO - European Journal of Vascular and Endovascular Surgery

JF - European Journal of Vascular and Endovascular Surgery

SN - 1078-5884

IS - 5

ER -