دورية أكاديمية
أعرض في EDS

Mortality analysis of endovascular aneurysm sealing versus endovascular aneurysm repair.

التفاصيل البيبلوغرافية
العنوان: Mortality analysis of endovascular aneurysm sealing versus endovascular aneurysm repair.
المؤلفون: Rastogi V; Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., O'Donnell TFX; Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA., Solomon Y; Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands., Varkevisser RRB; Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Patel PB; Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA., Carpenter JP; Division of Vascular Surgery, Cooper Medical School of Rowan University, Camden, NJ., de Bruin JL; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Reijnen MMPJ; Department of Surgery, Rijnstate, Arnhem, The Netherlands; Multi-Modality Medical Imaging Group, University of Twente, Enschede, The Netherlands., Verhagen HJM; Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands., Schermerhorn ML; Division of Vascular and Endovascular Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. Electronic address: mscherm@bidmc.harvard.edu.
المصدر: Journal of vascular surgery [J Vasc Surg] 2023 Mar; Vol. 77 (3), pp. 731-740.e1. Date of Electronic Publication: 2022 Oct 28.
نوع المنشور: Comparative Study; Journal Article; Research Support, N.I.H., Extramural
اللغة: English
بيانات الدورية: Publisher: Elsevier Country of Publication: United States NLM ID: 8407742 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1097-6809 (Electronic) Linking ISSN: 07415214 NLM ISO Abbreviation: J Vasc Surg Subsets: MEDLINE
أسماء مطبوعة: Publication: <2008-> : New York, NY : Elsevier
Original Publication: St. Louis, Mo. : Mosby, [c1984-
مواضيع طبية MeSH: Aortic Aneurysm, Abdominal*/surgery , Blood Vessel Prosthesis Implantation* , Endovascular Procedures*, Humans ; Blood Vessel Prosthesis ; Endovascular Aneurysm Repair ; Retrospective Studies ; Risk Factors ; Stents ; Treatment Outcome
مستخلص: Background: Endovascular aneurysm sealing (EVAS), using the Nellix endovascular aneurysm sealing system, has been associated with high reintervention and migration rates. However, prior reports have suggested that EVAS might be related to a lower all-cause mortality compared with endovascular aneurysm repair (EVAR). In the present study, we examined the 5-year all-cause mortality trends after EVAS and EVAR.
Methods: We compared the 333 EVAS patients in the EVAS-1 Nellix U.S. investigational device exemption trial with 16,497 infrarenal EVAR controls from the Vascular Quality Initiative, treated between 2014 and 2016, after applying the exclusion criteria from the investigational device exemption trial (ie, hemodialysis, creatinine >2.0 mg/dL, rupture). As a secondary analysis, we stratified the patients by aneurysm diameter (<5.5 cm and ≥5.5 cm). We calculated propensity scores after adjusting for demographics, comorbidities, and anatomic characteristics and applied inverse probability weighting to compare the risk-adjusted long-term mortality using Kaplan-Meier and Cox regression analyses.
Results: After weighting, the EVAS group had experienced similar 5-year mortality compared with the controls from the Vascular Quality Initiative (EVAS vs EVAR, 18% vs 14%; hazard ratio [HR], 1.1; 95% confidence interval [CI], 0.71-1.7; P = .70). The subgroup analysis demonstrated that for patients with an aneurysm diameter of <5.5 cm, EVAS was associated with higher 5-year mortality compared with EVAR (19% vs 11%; HR, 2.4; 95% CI, 1.7-4.7; P = .013). In patients with an aneurysm diameter of ≥5.5 cm, EVAS was associated with lower mortality within the first 2 years (2-year mortality: HR, 0.29; 95% CI, 0.13-0.62; P = .002). However, compared with EVAR, EVAS was associated with higher mortality between 2 and 5 years (HR, 1.9; 95% CI, 1.2-3.0; P = .005), with no mortality difference at 5 years (18% vs 17%; HR, 0.82; 95% CI, 0.4-1.4; P = .46).
Conclusions: Within the overall population, EVAS was associated with similar 5-year mortality compared with EVAR. EVAS was associated with higher mortality for those with small aneurysms (<5.5 cm). For those with larger aneurysms (≥5.5 cm), EVAS was initially associated with lower mortality within the first 2 years, although this advantage was lost thereafter, with higher mortality after 2 years. Future studies are required to evaluate the specific causes of death and to elucidate the potential beneficial mechanism behind sac obliteration that leads to this potential initial survival benefit. This could help guide the development of future grafts with better proximal fixation and sealing that also incorporate sac obliteration.
(Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
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معلومات مُعتمدة: T32 HL007734 United States HL NHLBI NIH HHS
فهرسة مساهمة: Keywords: Abdominal aortic aneurysm; Endovascular aneurysm repair; Endovascular aneurysm sealing; Mortality; Survival
تواريخ الأحداث: Date Created: 20230118 Date Completed: 20230305 Latest Revision: 20240302
رمز التحديث: 20240302
مُعرف محوري في PubMed: PMC9974809
DOI: 10.1016/j.jvs.2022.10.030
PMID: 36651654
قاعدة البيانات: MEDLINE
الوصف
تدمد:1097-6809
DOI:10.1016/j.jvs.2022.10.030