A population-based study of post-endovascular aortic repair rupture during 15 years

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Fältnamn	Indikatorer	Metadata
000		05041naa a2200457 4500
001		oai:gup.ub.gu.se/308644
003		SwePub
008		240528s2021 \| \|\|\|\|\|\|\|\|\|\|\|000 \|\|eng\|
009		oai:prod.swepub.kib.ki.se:147517747
024	7	a https://gup.ub.gu.se/publication/3086442 URI
024	7	a https://doi.org/10.1016/j.jvs.2021.01.0652 DOI
024	7	a http://kipublications.ki.se/Default.aspx?queryparsed=id:1475177472 URI
040		a (SwePub)gud (SwePub)ki
041		a eng
042		9 SwePub
072	7	a ref2 swepub-contenttype
072	7	a art2 swepub-publicationtype
100	1	a Andersson, Mattiasu Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine4 aut0 (Swepub:gu)xamatm
245	1 0	a A population-based study of post-endovascular aortic repair rupture during 15 years
264	1	b Elsevier BV,c 2021
520		a Objective: The devastating event of a ruptured abdominal aortic aneurysm (rAAA) in patients who have survived a previous AAA repair, either elective or urgent, is a feared and quite uncommon event. It has been suggested to partly explain the loss of the early survival benefit for endovascular aortic repair (EVAR) vs open surgical repair (OSR). The main objective of this study was to report the national incidence rate, risk factors and outcome of post-EVAR ruptures. Secondarily, the national incidence rate of ruptures after OSR (post-OSR ruptures) was investigated. Methods: We conducted a nationwide, population-based, retrospective cohort study using the inpatient and outpatient entries for all patients >40 years of age, receiving their first (index) surgical procedure for AAA, from 2001 to 2015. Only patients surviving their index procedure were included. The primary outcome was rAAA, registered after discharge from the index procedure (EVAR or OSR), identified in the Swedish National Patient Registry and the Cause of Death Registry. Results: In total, 14,859 patients survived their primary (index) AAA procedure. There were 6470 EVAR procedures, 5893 for intact AAA (iAAA) and 577 for rAAA. Of the 6470 EVAR patients, 86 cases of post-EVAR rupture were identified, corresponding with a cumulative incidence of 1.3% over a mean follow-up time of 3.9 years. The incidence rate was 3.4 (95% confidence interval [CI], 2.7-4.2)/1000 person-years. The independent risk factors identified for post-EVAR rupture were rAAA at index surgery HR 2.4 (95% CI, 1.4-4.1, p 0.002) and age (hazard ratio, 1.1; 95% CI, 1.0-1.1; P <.001). Freedom from post-EVAR rupture was 99%, 98%, and 96% at 3, 5, and 10 years, respectively. Total and postoperative mortality after post-EVAR rupture were 42% and 17% (30 days), 45% and 22% (90 days), and 53% and 33% (1 year). The incidence rate of post-OSR rupture was 0.9/1000 person-years (95% CI, 0.7-1.2). Conclusions: Post-EVAR rupture is a rare complication that can occur at any time after the index EVAR procedure. This finding may have implications for the discussion of limited follow-up programs and for the choice of procedure in patients with an AAA with a long life expectancy. An rAAA as the indication for the index surgery and age were identified as risk factors for post-EVAR rupture. The mortality associated with post-EVAR rupture is high, but lower than that of primary rAAA. The much lower risk of post-OSR rupture was confirmed, but must not be neglected as a possible late complication. © 2021 The Authors
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kirurgi0 (SwePub)302122 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Surgery0 (SwePub)302122 hsv//eng
650	7	a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Kardiologi0 (SwePub)302062 hsv//swe
650	7	a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Cardiac and Cardiovascular Systems0 (SwePub)302062 hsv//eng
653		a Abdominal aortic aneurysm
653		a Complications
653		a EVAR
653		a Open repair
653		a Rupture
700	1	a Talvitie, M.u Karolinska Institutet4 aut
700	1	a Benson, L.u Karolinska Institutet4 aut
700	1	a Roy, J.u Karolinska Institutet4 aut
700	1	a Roos, Håkan,d 1967u Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine4 aut0 (Swepub:gu)xrooha
700	1	a Hultgren, R.u Karolinska Institutet4 aut
710	2	a Göteborgs universitetb Institutionen för medicin, avdelningen för molekylär och klinisk medicin4 org
773	0	t Journal of Vascular Surgeryd : Elsevier BVg 74:3q 74:3x 0741-5214x 1097-6809
856	4	u http://www.jvascsurg.org/article/S0741521421002330/pdf
856	4 8	u https://gup.ub.gu.se/publication/308644
856	4 8	u https://doi.org/10.1016/j.jvs.2021.01.065
856	4 8	u http://kipublications.ki.se/Default.aspx?queryparsed=id:147517747

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Av författaren/redakt...: Andersson, Matti ...; Talvitie, M.; Benson, L.; Roy, J.; Roos, Håkan, 196 ...; Hultgren, R.

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kirurgi

MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Kardiologi

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