Predictors and outcomes of endoleaks in the Veterans Affairs Open Versus Endovascular Repair (OVER) Trial of Abdominal Aortic Aneurysms
Predictors and outcomes of endoleaks in the Veterans Affairs Open Versus Endovascular Repair (OVER) Trial of Abdominal Aortic Aneurysms
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DOI：
10.1016/j.jvs.2015.02.003
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发表时间：
2015-12-01
影响因子：
4.3
通讯作者：
Freischlag, Julie
中科院分区：
文献类型：
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作者：
Lal, Brajesh K.;Zhou, Wei;Freischlag, Julie
目标：退伍军人事务部腹主动脉瘤开放与腔内修复（OVER）试验研究是一项随机对照试验，比较了肾下主动脉瘤标准风险患者的开放与腔内修复（EVAR）。本文报告的分析确定了OVER队列中腹主动脉瘤腔内修复术治疗患者内漏的特征、风险因素和长期结局。方法：OVER试验入组了881例患者，其中439例成功接受了腹主动脉瘤腔内修复术。使用逻辑回归分析确定内漏和二次干预的预测因素。使用Kaplan-Meier生存分析、纵向图和广义线性混合模型方法来描述内漏检测、解决或死亡的时间。结果：在平均6.2 +/- 2.4年的随访期间，135例患者（30.5%）发生了187例内漏。4名腹主动脉瘤腔内修复术患者继续破裂;这4名患者并非都有内漏。发生内漏和未发生内漏的患者之间的死亡率无显著差异。187例内漏包括12%的I型、76%的II型、3%的III型、3%的IV型和6%的不确定型。患者人口统计学和血管风险因素与内漏发生无关。内漏的存在导致动脉瘤直径随时间增加（P
Objective: The Veterans Affairs Open Versus Endovascular Repair (OVER) Trial of Abdominal Aortic Aneurysms study was a randomized controlled trial comparing open vs endovascular repair (EVAR) in standard-risk patients with infrarenal aortic aneurysms. The analysis reported here identifies characteristics, risk factors, and long-term outcome of endoleaks in patients treated with EVAR in the OVER cohort.Methods: The OVER trial enrolled 881 patients, of whom 439 received successful EVAR. Logistic regression analysis was used to identify predictors for endoleaks and secondary interventions. Kaplan-Meier survival analysis, longitudinal plots, and generalized linear mixed models methods were used to describe time to endoleak detection, resolution, or death.Results: During a mean follow-up of 6.2 +/- 2.4 years, 135 patients (30.5%) developed 187 endoleaks. Four patients with EVAR went on to rupture; these four patients did not all have an endoleak. Mortality between patients who did and did not develop endoleaks was not significantly different. The 187 endoleaks included 12% type I, 76% type II, 3% type III, 3% type IV, and 6% indeterminate. Patient demographics and vascular risk factors were not associated with endoleak development. The presence of endoleaks resulted in an increase in aneurysm diameter over time (P