Redefining postoperative surveillance after endovascular aneurysm repair: Recommendations based on 5-year follow-up in the US Zenith multicenter trial
Redefining postoperative surveillance after endovascular aneurysm repair: Recommendations based on 5-year follow-up in the US Zenith multicenter trial
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DOI：
10.1016/j.jvs.2008.02.075
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发表时间：
2008-08-01
影响因子：
4.3
通讯作者：
Tonnessen, Britt H.
中科院分区：
文献类型：
--
作者：
Sternbergh, W. Charles, III;Greenberg, Roy K.;Tonnessen, Britt H.
导言：推荐的血管内动脉瘤修复术(EVAR)术后监测包括系列对比增强CT扫描。这种监测方案对肾功能、辐射暴露和巨大成本的累积有害影响都是有问题的。然而，目前EVAR后监测方案的调整缺乏数据支持。这项研究包括接受EVAR的患者，这是预期的多中心枢轴(第二阶段)和持续进入(第三阶段)US Zenith Endovailures(Cook，Bloomington，IND)移植试验的一部分。一个核心实验室前瞻性地记录了患者数据。计算的复合动脉瘤相关发病率(ARM)变量包括动脉瘤破裂、开放中转、任何二次介入、肢体血栓形成、移行、肾脏疾病或动脉瘤相关死亡。分析在术后1、6和12个月，长期脱离ARM的情况与有无内渗漏的关系。在12个月时评估动脉瘤囊收缩(<gt；=5 mm)的潜在相加预测价值。主动脉颈解剖使用说明书(长度15分钟，直径18~28 mm，1年)。在大多数患者中，这种减少的监测方案将是适当的，并可以通过减少静脉造影剂和辐射暴露的累积有害影响，同时降低医疗保健成本来提高患者的安全性。这些主观的建议将在随机、前瞻性试验中得到理想的验证。
Introduction: Recommended postoperative surveillance after endovascular aneurysm repair (EVAR) includes serial contrast-enhanced CT scans. The cumulative deleterious effect on renal function, radiation exposure, and significant cost of this surveillance regimen are all problematic. However, there are scant data to support modulation of current post-EVAR surveillance regimens.Methods. The study comprised patients who underwent EVAR as part of the prospective multicenter pivotal (phase II) and continued-access (phase III) US Zenith Endovascular (Cook, Bloomington, Ind) graft trials. A core lab prospectively recorded patient data. A composite aneurysm-related morbidity (ARM) variable was calculated to include aneurysm rupture, open conversion, any secondary intervention, limb thrombosis, migration, renal morbidity, or aneurysm-related death. The long-term freedom from ARM as a function of the presence or cumulative absence of any endoleak at 1, 6, and 12 months was analyzed. The potential additive predictive utility of aneurysm sac shrinkage (>= 5 mm) was assessed at 12 months. The instructions for use for aortic neck anatomy (>= 15 min length, 18 to 28 mm diameter, 1 year. In most patients, this reduced surveillance regimen would be appropriate and could improve patient safety by reducing the cumulative deleterious effects of intravenous contrast and radiation exposure while also reducing health care costs. These subjective recommendations would be ideally validated in a randomized, prospective trial.