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@article{Grootes:2018:10.1002/bjs.10964,
author = {Grootes, I and Barrett, JK and Ulug, P and Rohlffs, FEV and Laukontaus, SJ and Tulamo, R and Venermo, M and Greenhalgh, RM and Sweeting, MJ},
doi = {10.1002/bjs.10964},
journal = {British Journal of Surgery},
pages = {1294--1304},
title = {Predicting risk of rupture and rupture-preventing re-interventions utilising repeated measures on aneurysm sac diameter following endovascular abdominal aortic aneurysm repair},
url = {http://dx.doi.org/10.1002/bjs.10964},
volume = {105},
year = {2018}
}

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TY  - JOUR
AB  - BackgroundClinical 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 (rupturepreventing reintervention) to enable the development of personalized surveillance intervals.MethodsBaseline data and repeat measurements of postoperative aneurysm sac diameter from the EVAR1 and EVAR2 trials were used to develop the model, with external validation in a cohort from a singlecentre vascular database. Longitudinal mixedeffects models were fitted to trajectories of sac diameter, and modelpredicted sac diameter and rate of growth were used in prognostic Cox proportional hazards models.ResultsSome 785 patients from the EVAR trials were included, of whom 155 (19·7 per cent) experienced at least one rupture or required a rupturepreventing reintervention during followup. 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 (Cindex 0·68), 3 years (Cindex 0·72) and 5 years (Cindex 0·75) after operation and had excellent external validation (Cindex 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.ConclusionSecondary sac growth is an important predictor of rupture or rupturepreventing reintervention to enable the development of personalized surveillance intervals. A dynamic prognostic model has the potential to tailor surveillance by identi
AU  - Grootes,I
AU  - Barrett,JK
AU  - Ulug,P
AU  - Rohlffs,FEV
AU  - Laukontaus,SJ
AU  - Tulamo,R
AU  - Venermo,M
AU  - Greenhalgh,RM
AU  - Sweeting,MJ
DO  - 10.1002/bjs.10964
EP  - 1304
PY  - 2018///
SN  - 1365-2168
SP  - 1294
TI  - Predicting risk of rupture and rupture-preventing re-interventions utilising repeated measures on aneurysm sac diameter following endovascular abdominal aortic aneurysm repair
T2  - British Journal of Surgery
UR  - http://dx.doi.org/10.1002/bjs.10964
UR  - http://hdl.handle.net/10044/1/61941
VL  - 105
ER  -

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