PURPOSE:Endovascular aneurysm repair (EVAR) is associated with high graft-related complication rates during follow-up. Anatomical fit between patient and endograft could be an important factor for successful treatment. Aim was to assess whether extent of thrombus, calcification, angulation, and tortuosity are associated with occurrence of complications after EVAR. MATERIALS AND METHODS:Patients in either United Kingdom EVAR trial 1 or 2 were included if they had undergone EVAR within 6 months of randomization and had a preoperative computed tomography (CT) scan of adequate quality in the core laboratory. Three-dimensional CT imaging was used to assess extent of preoperative thrombus, calcification, angulation, and tortuosity in aneurysm neck and iliac segments. Cox regression modeling, adjusted for the variables tested and for known confounding variables, was used to investigate whether these factors were associated with increased rates of reported first complications. RESULTS: A total of 217 patients with 53 first graft-related complications were analyzed after a mean follow-up of 3.6 years. Adjusted hazard ratios (95% confidence intervals, P values) for complications per unit increase of variable were 0.96 (0.92-0.99, 0.018) for neck thrombus, 1.06 (1.00-1.12, 0.044) for neck calcification, 1.02 (1.00-1.05, 0.079) for neck angulation, 1.04 (1.01-1.06, 0.011) for common iliac thrombus, 0.96 (0.93-1.00, 0.033) for common iliac calcification, and 5.96 (1.53-23.28, 0.010) for common iliac tortuosity. CONCLUSION:Increased neck angulation and calcification and common iliac thrombus and tortuosity are associated with higher rates of graft-related complications after EVAR. Increased neck thrombus and common iliac calcification appear to protect against complications. Careful evaluation of these factors prior to EVAR might lead to lower complication rates.
RCT Entities:
PURPOSE:Endovascular aneurysm repair (EVAR) is associated with high graft-related complication rates during follow-up. Anatomical fit between patient and endograft could be an important factor for successful treatment. Aim was to assess whether extent of thrombus, calcification, angulation, and tortuosity are associated with occurrence of complications after EVAR. MATERIALS AND METHODS:Patients in either United Kingdom EVAR trial 1 or 2 were included if they had undergone EVAR within 6 months of randomization and had a preoperative computed tomography (CT) scan of adequate quality in the core laboratory. Three-dimensional CT imaging was used to assess extent of preoperative thrombus, calcification, angulation, and tortuosity in aneurysm neck and iliac segments. Cox regression modeling, adjusted for the variables tested and for known confounding variables, was used to investigate whether these factors were associated with increased rates of reported first complications. RESULTS: A total of 217 patients with 53 first graft-related complications were analyzed after a mean follow-up of 3.6 years. Adjusted hazard ratios (95% confidence intervals, P values) for complications per unit increase of variable were 0.96 (0.92-0.99, 0.018) for neck thrombus, 1.06 (1.00-1.12, 0.044) for neck calcification, 1.02 (1.00-1.05, 0.079) for neck angulation, 1.04 (1.01-1.06, 0.011) for common iliac thrombus, 0.96 (0.93-1.00, 0.033) for common iliac calcification, and 5.96 (1.53-23.28, 0.010) for common iliac tortuosity. CONCLUSION: Increased neck angulation and calcification and common iliac thrombus and tortuosity are associated with higher rates of graft-related complications after EVAR. Increased neck thrombus and common iliac calcification appear to protect against complications. Careful evaluation of these factors prior to EVAR might lead to lower complication rates.
Authors: Nandini M Meyersohn; Khristine Ghemigian; Michael D Shapiro; Shimoli V Shah; Brian B Ghoshhajra; Maros Ferencik Journal: Curr Treat Options Cardiovasc Med Date: 2015-08
Authors: Alan Karthikesalingam; Omneya Attallah; Xianghong Ma; Sandeep Singh Bahia; Luke Thompson; Alberto Vidal-Diez; Edward C Choke; Matt J Bown; Robert D Sayers; Matt M Thompson; Peter J Holt Journal: PLoS One Date: 2015-07-15 Impact factor: 3.240
Authors: Hyunwook Kwon; Do Yun Lee; Soo Jin Na Choi; Ki Hyuk Park; Seung-Kee Min; Jeong-Hwan Chang; Seung Huh; Yong Sun Jeon; Jehwan Won; Seung Jae Byun; Sang Jun Park; Lee Chan Jang; Tae-Won Kwon Journal: Vasc Specialist Int Date: 2015-09-30
Authors: Omneya Attallah; Alan Karthikesalingam; Peter J E Holt; Matthew M Thompson; Rob Sayers; Matthew J Bown; Eddie C Choke; Xianghong Ma Journal: BMC Med Inform Decis Mak Date: 2017-08-03 Impact factor: 2.796