Publications
476 results found
Grieve R, Gomes M, Sweeting MJ, et al., 2015, Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial, European Heart Journal, Vol: 36, Pages: 2061-2069, ISSN: 1522-9645
AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791.
Hinchliffe RJ, Powell JT, 2015, Improving the outcomes from ruptured abdominal aortic aneurysm: interdisciplinary best practice guidelines, Annals of the Royal College of Surgeons of England, Vol: 95, Pages: 96-97, ISSN: 1478-7083
Bjorck M, Bown MJ, Choke E, et al., 2015, International Update on Screening for Abdominal Aortic Aneurysms: Issues and Opportunities, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 49, Pages: 113-115, ISSN: 1078-5884
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- Citations: 28
Powell JT, Sweeting MJ, Thompson MM, et al., 2015, The effect of aortic morphology on peri-operative mortality of ruptured abdominal aortic aneurysm, European Heart Journal, Vol: 36, Pages: 1328-U137, ISSN: 1522-9645
The influence of six morphological parameters (maximum aortic diameter, aneurysm neck diameter, length and conicality,proximal neck angle, and maximum common iliac diameter) on mortality and reinterventions within 30 days was investigatedin rAAA patients randomized before morphological assessment in the Immediate Management of the Patient withRupture: Open Versus Endovascular strategies (IMPROVE) trial. Patients with a proven diagnosis of rAAA, who underwentrepair and had their admission computerized tomography scan submitted to the core laboratory, were included.Among 458 patients (364 men, mean age 76 years), who had either EVAR (n ¼ 177) or open repair (n ¼ 281) started,there were 155 deaths and 88 re-interventions within 30 days of randomization analysed according to a pre-specifiedplan. The mean maximum aortic diameter was 8.6 cm. There were no substantial correlations between the six morphologicalvariables. Aneurysm neck length was shorter in those undergoing open repair (vs. EVAR). Aneurysm neck length(mean 23.3, SD 16.1 mm) was inversely associated with mortality for open repair and overall: adjusted OR 0.72 (95% CI0.57, 0.92) for each 16 mm (SD) increase in length. There were no convincing associations of morphological parameterswith reinterventions.
von Allmen RS, Anjum A, Powell JT, et al., 2015, Hospital trends of admissions and procedures for acute leg ischaemia in England, 2000-2011, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 97, Pages: 59-62, ISSN: 0035-8843
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- Citations: 8
Filardo G, Powell JT, Martinez MA-M, et al., 2015, Surgery for small asymptomatic abdominal aortic aneurysms, COCHRANE DATABASE OF SYSTEMATIC REVIEWS, ISSN: 1469-493X
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- Citations: 59
Hinchliffe RJ, Powell JT, 2014, The Value of Registries for Rare Diseases Bacterial or Mycotic Aortic Aneurysm, CIRCULATION, Vol: 130, Pages: 2129-2130, ISSN: 0009-7322
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- Citations: 5
Vavra AK, Kibbe MR, Bown MJ, et al., 2014, Debate: Whether evidence supports reducing the threshold diameter to 5 cm for elective interventions in women with abdominal aortic aneurysms, JOURNAL OF VASCULAR SURGERY, Vol: 60, Pages: 1695-1698, ISSN: 0741-5214
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- Citations: 2
Bown MJ, Powell JT, 2014, Part Two: Against the Motion. Evidence Does Not Support Reducing the Threshold Diameter to 5 cm for Elective Interventions in Women with Abdominal Aortic Aneurysms, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 48, Pages: 614-618, ISSN: 1078-5884
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- Citations: 6
Filardo G, Lederle FA, Ballard DJ, et al., 2014, Effect of Age on Survival Between Open Repair and Surveillance for Small Abdominal Aortic Aneurysms, AMERICAN JOURNAL OF CARDIOLOGY, Vol: 114, Pages: 1281-1286, ISSN: 0002-9149
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- Citations: 3
Lederle FA, Powell JT, Nienaber CA, 2014, Does intensive medical treatment improve outcomes in aortic dissection?, BMJ-BRITISH MEDICAL JOURNAL, Vol: 349, ISSN: 1756-1833
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- Citations: 8
von Allmen RS, Anjum A, Powell JT, 2014, Outcomes after endovascular or open repair for degenerative descending thoracic aortic aneurysm using linked hospital data, BRITISH JOURNAL OF SURGERY, Vol: 101, Pages: 1244-1251, ISSN: 0007-1323
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- Citations: 41
Rudarakanchana N, Reeves BC, Bicknell CD, et al., 2014, Editor's Choice - Treatment Decisions for Descending Thoracic Aneurysm: Preferences for Thoracic Endovascular Aneurysm Repair or Surveillance in a Discrete Choice Experiment, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 48, Pages: 13-22, ISSN: 1078-5884
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- Citations: 5
von Allmen RS, Anjum A, Powell JT, 2014, Endovascular versus open repair for degenerative descending thoracic aortic aneurysm: Linked hospital data for England, 101st Annual Congress of the Swiss-Society-of-Surgery, Publisher: WILEY-BLACKWELL, Pages: 19-19, ISSN: 0007-1323
Doyle BJ, McGloughlin TM, Miller K, et al., 2014, Regions of High Wall Stress Can Predict the Future Location of Rupture of Abdominal Aortic Aneurysm, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 37, Pages: 815-818, ISSN: 0174-1551
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- Citations: 34
Epstein D, Sculpher MJ, Powell JT, et al., 2014, Long-term cost-effectiveness analysis of endovascular versus open repair for abdominal aortic aneurysm based on four randomized clinical trials, BRITISH JOURNAL OF SURGERY, Vol: 101, Pages: 623-631, ISSN: 0007-1323
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- Citations: 68
Daugherty A, Powell JT, 2014, Recent Highlights of ATVB Aneurysms, ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, Vol: 34, Pages: 691-694, ISSN: 1079-5642
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- Citations: 18
Powell JT, Hinchliffe RJ, Thompson MM, et al., 2014, An Endovascular Strategy for Suspected Ruptured Abdominal Aortic Aneurysm Brings Earlier Home Discharge but Not Early Survival or Cost Benefits, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 47, Pages: 333-334, ISSN: 1078-5884
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- Citations: 3
von Allmen RS, Anjum A, Powell JT, 2014, Endovascular versus open repair for descending thoracic aortic aneurysm: linked hospital data for England (2006-2011), 48th Annual Scientific Meeting of the Vascular-Society-of-Great-Britain-and-Ireland, Publisher: WILEY-BLACKWELL, Pages: 8-8, ISSN: 0007-1323
Powell JT, Hinchliffe RJ, Thompson MM, et al., 2014, Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm, British Journal of Surgery, Vol: 101, Pages: 216-224, ISSN: 1365-2168
Background: Single-centre series of the management of patients with ruptured abdominal aorticaneurysm (AAA) are usually too small to identify clinical factors that could improve patient outcomes.Methods: IMPROVE is a pragmatic, multicentre randomized clinical trial in which eligible patients witha clinical diagnosis of ruptured aneurysm were allocated to a strategy of endovascular aneurysm repair(EVAR) or to open repair. The influences of time and manner of hospital presentation, fluid volumestatus, type of anaesthesia, type of endovascular repair and time to aneurysm repair on 30-day mortalitywere investigated according to a prespecified plan, for the subgroup of patients with a proven diagnosisof ruptured or symptomatic AAA. Adjustment was made for potential confounding factors.Results: Some 558 of 613 randomized patients had a symptomatic or ruptured aneurysm: diagnosticaccuracy was 91·0 per cent. Patients randomized outside routine working hours had higher operativemortality (adjusted odds ratio (OR) 1·47, 95 per cent confidence interval 1·00 to 2·17). Mortality ratesafter primary and secondary presentation were similar. Lowest systolic blood pressure was stronglyand independently associated with 30-day mortality (51 per cent among those with pressure below 70mmHg). Patients who received EVAR under local anaesthesia alone had greatly reduced 30-day mortalitycompared with those who had general anaesthesia (adjusted OR 0·27, 0·10 to 0·70).Conclusion: These findings suggest that the outcome of ruptured AAA might be improved by wider useof local anaesthesia for EVAR and that a minimum blood pressure of 70 mmHg is too low a thresholdfor permissive hypotension.
Norman PE, Powell JT, 2014, Vitamin D and Cardiovascular Disease, CIRCULATION RESEARCH, Vol: 114, Pages: 379-393, ISSN: 0009-7330
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- Citations: 335
Powell JT, Sweeting MJ, Thompson MM, et al., 2014, Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial, British Medical Journal, Vol: 348, Pages: 1-12, ISSN: 1468-5833
Objective To assess whether a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair reduces early mortality for patients with suspected ruptured abdominal aortic aneurysm.Design Randomised controlled trial.Setting 30 vascular centres (29 UK, 1 Canadian), 2009-13.Participants 613 eligible patients (480 men) with a clinical diagnosis of ruptured aneurysm.Interventions 316 patients were randomised to the endovascular strategy (275 confirmed ruptures, 174 anatomically suitable for endovascular repair) and 297 to open repair (261 confirmed ruptures).Main outcome measures 30 day mortality, with 24 hour and in-hospital mortality, costs, and time and place of discharge as secondary outcomes.Results 30 day mortality was 35.4% (112/316) in the endovascular strategy group and 37.4% (111/297) in the open repair group: odds ratio 0.92 (95% confidence interval 0.66 to 1.28; P=0.62); odds ratio after adjustment for age, sex, and Hardman index 0.94 (0.67 to 1.33). Women may benefit more than men (interaction test P=0.02) from the endovascular strategy: odds ratio 0.44 (0.22 to 0.91) versus 1.18 (0.80 to 1.75). 30 day mortality for patients with confirmed rupture was 36.4% (100/275) in the endovascular strategy group and 40.6% (106/261) in the open repair group (P=0.31). More patients in the endovascular strategy than in the open repair group were discharged directly to home (189/201 (94%) v 141/183 (77%); P<0.001). Average 30 day costs were similar between the randomised groups, with an incremental cost saving for the endovascular strategy versus open repair of £1186 (€1420; $1939) (95% confidence interval −£625 to £2997).Conclusions A strategy of endovascular repair was not associated with significant reduction in either 30 day mortality or cost. Longer term cost effectiveness evaluations are needed to assess the full effects of the endovascular strategy in both men and women.
Rudarakanchana N, Bicknell CD, Cheshire NJ, et al., 2014, Variation in Maximum Diameter Measurements of Descending Thoracic Aortic Aneurysms Using Unformatted Planes versus Images Corrected to Aortic Centerline, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 47, Pages: 19-26, ISSN: 1078-5884
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- Citations: 16
Powell JT, 2013, The Circuitous Route to Pivotal Mechanisms in Aortic Aneurysm Formation. Commentary regarding EJVES8677R, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 46, Pages: 557-557, ISSN: 1078-5884
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- Citations: 2
Bradley DT, Hughes AE, Badger SA, et al., 2013, A Variant in <i>LDLR</i> Is Associated With Abdominal Aortic Aneurysm, CIRCULATION-CARDIOVASCULAR GENETICS, Vol: 6, Pages: 498-504, ISSN: 1942-325X
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- Citations: 62
Thompson SG, Brown LC, Sweeting MJ, et al., 2013, Systematic review and meta-analysis of the growth and rupture rates of small abdominal aortic aneurysms: implications for surveillance intervals and their cost-effectiveness, HEALTH TECHNOLOGY ASSESSMENT, Vol: 17, Pages: 1-+, ISSN: 1366-5278
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- Citations: 131
Filardo G, Lederle FA, Ballard DJ, et al., 2013, Immediate Open Repair vs Surveillance in Patients with Small Abdominal Aortic Aneurysms: Survival Differences by Aneurysm Size, MAYO CLINIC PROCEEDINGS, Vol: 88, Pages: 910-919, ISSN: 0025-6196
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- Citations: 18
Powell JT, Thompson SG, 2013, Should the Frequency of Surveillance for Small Abdominal Aortic Aneurysms be Reduced?, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 46, Pages: 171-172, ISSN: 1078-5884
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- Citations: 5
Jones GT, Bown MJ, Gretarsdottir S, et al., 2013, A sequence variant associated with sortilin-1 (<i>SORT1</i>) on 1p13.3 is independently associated with abdominal aortic aneurysm, HUMAN MOLECULAR GENETICS, Vol: 22, Pages: 2941-2947, ISSN: 0964-6906
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- Citations: 70
Rudarakanchana N, Powell JT, 2013, Advances in Imaging and Surveillance of AAA: When, How, How Often?, PROGRESS IN CARDIOVASCULAR DISEASES, Vol: 56, Pages: 7-12, ISSN: 0033-0620
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- Citations: 11
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