Predicting risk of rupture and rupture-preventing reinterventions following endovascular abdominal aortic aneurysm repair.
Predicting risk of rupture and rupture-preventing reinterventions following endovascular abdominal aortic aneurysm repair.
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DOI：
10.1002/bjs.10964
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发表时间：
2018-09
期刊：
影响因子：
--
通讯作者：
Sweeting MJ
中科院分区：
文献类型：
--
作者：
Grootes I;Barrett JK;Ulug P;Rohlffs F;Laukontaus SJ;Tulamo R;Venermo M;Greenhalgh RM;Sweeting MJ
完整腹主动脉瘤（AAA）的腹主动脉瘤腔内修复术（EVAR）后的临床和影像学监测实践差异很大，对建议的终身监测的依从性较差。本研究的目的是开发一种动态预后模型，以便对未来有继发性主动脉破裂风险或需要干预预防破裂（预防破裂-再次干预）的患者进行分层，从而制定个性化的监测间隔。使用腹主动脉瘤腔内修复术-1和腹主动脉瘤腔内修复术-2试验的基线数据和术后动脉瘤囊直径的重复测量值开发模型，并在来自单中心血管数据库的队列中进行外部确认。将纵向混合效应模型拟合到囊直径的轨迹，并将模型预测的囊直径和生长速率用于预后考克斯比例风险模型。纳入了来自腹主动脉瘤腔内修复术试验的约785例患者，其中155例（19.7%）在随访期间发生了至少一次破裂或需要预防破裂的再次干预。风险增加与术前AAA大小、囊生长率和先前检测到的并发症数量相关。仅使用预测囊生长的预后模型在术后2年（C-指数0·68）、3年（C-指数0·72）和5年（C-指数0·75）时具有良好的区分度，并且具有极好的外部验证（C-指数0·76-0·79）。手术后5年以上，生长速度超过1毫米/年，在识别2年内发生的事件时，敏感性超过80%，特异性超过50%。继发性囊生长是破裂或破裂的重要预测因素，可防止再次干预，从而制定个性化的监测间隔。动态预后模型有可能通过识别大部分可能需要较低强度随访的患者来定制监测。定制监视的潜力
Clinical 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. The aim of this study was to develop a dynamic prognostic model to enable stratification of patients at risk of future secondary aortic rupture or the need for intervention to prevent rupture (rupture‐preventing reintervention) to enable the development of personalized surveillance intervals. Baseline data and repeat measurements of postoperative aneurysm sac diameter from the EVAR‐1 and EVAR‐2 trials were used to develop the model, with external validation in a cohort from a single‐centre vascular database. 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. Some 785 patients from the EVAR trials were included, of whom 155 (19·7 per cent) experienced at least one rupture or required a rupture‐preventing reintervention during follow‐up. An increased risk was associated with preoperative AAA size, rate of sac growth and the number of previously detected complications. A prognostic model using predicted sac growth alone had good discrimination at 2 years (C‐index 0·68), 3 years (C‐index 0·72) and 5 years (C‐index 0·75) after operation and had excellent external validation (C‐index 0·76–0·79). More than 5 years after operation, growth rates above 1 mm/year had a sensitivity of over 80 per cent and specificity over 50 per cent in identifying events occurring within 2 years. Secondary sac growth is an important predictor of rupture or rupture‐preventing reintervention to enable the development of personalized surveillance intervals. A dynamic prognostic model has the potential to tailor surveillance by identifying a large proportion of patients who may require less intensive follow‐up. Potential to tailor surveillance
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影响因子：
4.3
作者：
Noll, Robert E., Jr.;Tonnessen, Britt H.;Sternbergh, W. Charles, III
通讯作者：
Sternbergh, W. Charles, III
影响因子：
4.3
作者：
Sternbergh, W. Charles, III;Greenberg, Roy K.;Tonnessen, Britt H.
通讯作者：
Tonnessen, Britt H.
影响因子：
9.6
作者：
Epstein, D.;Sculpher, M. J.;Greenhalgh, R. M.
通讯作者：
Greenhalgh, R. M.
DOI：
10.1016/j.ejvs.2010.09.011
发表时间：
2011-01-01
影响因子：
5.7
作者：
Moll, F. L.;Powell, J. T.;Rica, J-B
通讯作者：
Rica, J-B
影响因子：
4.3
作者：
Schwarze, Margaret L.;Shen, Yang;Dale, William
通讯作者：
Dale, William