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

IMPROVE trial investigators

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)625-632
Number of pages8
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume55
Issue number5
DOIs
Publication statusPublished - May 2018
Externally publishedYes

Bibliographical note

Funding Information:
This project was funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 07/37/64 )). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, National Health Service, or the Department of Health.

Funding Information:
This project was funded by the UK National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project number 07/37/64)). The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, National Health Service, or the Department of Health.

Publisher Copyright:
© 2018 The Authors

Keywords

  • Abdominal aortic aneurysm
  • Morphology
  • Re-intervention
  • Rupture

Fingerprint

Dive into the research topics of 'Editor's Choice – Re-interventions After Repair of Ruptured Abdominal Aortic Aneurysm: A Report From the IMPROVE Randomised Trial'. Together they form a unique fingerprint.

Cite this