Imperial College London


Faculty of MedicineDepartment of Surgery & Cancer

Visiting Professor



+44 (0)20 3311 7312j.powell




4E05Charing Cross HospitalCharing Cross Campus






BibTex format

author = {Powell, JT and Sweeting, MJ and Ulug, P and Thompson, MM and Hinchliffe, RJ and IMPROVE, Trial Investigators},
doi = {10.1016/j.ejvs.2018.01.028},
journal = {European Journal of Vascular and Endovascular Surgery},
pages = {625--632},
title = {Re-interventions after repair of ruptured abdominal aortic aneurysm: a report from the IMPROVE randomised trial},
url = {},
volume = {55},
year = {2018}

RIS format (EndNote, RefMan)

AB - 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-inte
AU - Powell,JT
AU - Sweeting,MJ
AU - Ulug,P
AU - Thompson,MM
AU - Hinchliffe,RJ
AU - IMPROVE,Trial Investigators
DO - 10.1016/j.ejvs.2018.01.028
EP - 632
PY - 2018///
SN - 1078-5884
SP - 625
TI - Re-interventions after repair of ruptured abdominal aortic aneurysm: a report from the IMPROVE randomised trial
T2 - European Journal of Vascular and Endovascular Surgery
UR -
UR -
UR -
VL - 55
ER -