Predictive value of negative initial postoperative imaging after endovascular aortic aneurysm repair

Heather L. Gill, Stephanie Ladowski, Monisha Sudarshan, Kent S. Mackenzie, Marc M. Corriveau, Cherrie Abraham, Daniel I. Obrand, Oren K. Steinmetz

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective The risk of endoleak and reintervention after endovascular abdominal aortic aneurysm repair necessitates lifelong surveillance, which has associated costs, radiation exposure, and risk of nephrotoxicity. The best imaging method and timing of surveillance remain controversial. We sought to determine if a negative result of first postoperative imaging by computed tomography (CT) scan was predictive of decreased need for reintervention. We hypothesized that initial negative postoperative imaging could identify a low-risk cohort of patients who could be observed less frequently. Methods Retrospective review of prospectively collected institutional outcomes data (2004-2009) included stratification according to postoperative imaging results. Baseline characteristics and aneurysm morphology were compared between the two groups. Cox regression analysis was used to identify risk factors predictive for endoleak-related reintervention. Kaplan-Meier survival curves were used to plot freedom from all-cause reintervention and endoleak-related reintervention for the two groups. Results A total of 134 patients were included in the analysis. A total of 107 patients (80%) had negative initial postoperative imaging, whereas 27 patients (20%) had evidence of an endoleak. There were no significant differences between the two groups in terms of comorbidities or anticoagulation status. Kaplan-Meier survival curves showed that there was a significant difference between those patients who had a negative initial CT scan and those who had a positive scan for endoleak in terms of both overall reintervention rates and leak-related reintervention rates. Endoleak on the first postoperative CT scan was associated with a hazard ratio of 6.37 (confidence interval, 2.02-20.10; P =.002) for leak-related reintervention and a hazard ratio of 6.01 (confidence interval, 2.24-16.17; P

Original languageEnglish (US)
Pages (from-to)325-329
Number of pages5
JournalJournal of Vascular Surgery
Volume60
Issue number2
DOIs
StatePublished - 2014
Externally publishedYes

Fingerprint

Endoleak
Aortic Aneurysm
Tomography
Kaplan-Meier Estimate
Confidence Intervals
Abdominal Aortic Aneurysm
Aneurysm
Comorbidity
Regression Analysis
Costs and Cost Analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Gill, H. L., Ladowski, S., Sudarshan, M., Mackenzie, K. S., Corriveau, M. M., Abraham, C., ... Steinmetz, O. K. (2014). Predictive value of negative initial postoperative imaging after endovascular aortic aneurysm repair. Journal of Vascular Surgery, 60(2), 325-329. https://doi.org/10.1016/j.jvs.2014.03.005

Predictive value of negative initial postoperative imaging after endovascular aortic aneurysm repair. / Gill, Heather L.; Ladowski, Stephanie; Sudarshan, Monisha; Mackenzie, Kent S.; Corriveau, Marc M.; Abraham, Cherrie; Obrand, Daniel I.; Steinmetz, Oren K.

In: Journal of Vascular Surgery, Vol. 60, No. 2, 2014, p. 325-329.

Research output: Contribution to journalArticle

Gill, HL, Ladowski, S, Sudarshan, M, Mackenzie, KS, Corriveau, MM, Abraham, C, Obrand, DI & Steinmetz, OK 2014, 'Predictive value of negative initial postoperative imaging after endovascular aortic aneurysm repair', Journal of Vascular Surgery, vol. 60, no. 2, pp. 325-329. https://doi.org/10.1016/j.jvs.2014.03.005
Gill, Heather L. ; Ladowski, Stephanie ; Sudarshan, Monisha ; Mackenzie, Kent S. ; Corriveau, Marc M. ; Abraham, Cherrie ; Obrand, Daniel I. ; Steinmetz, Oren K. / Predictive value of negative initial postoperative imaging after endovascular aortic aneurysm repair. In: Journal of Vascular Surgery. 2014 ; Vol. 60, No. 2. pp. 325-329.
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AU - Sudarshan, Monisha

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AU - Abraham, Cherrie

AU - Obrand, Daniel I.

AU - Steinmetz, Oren K.

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N2 - Objective The risk of endoleak and reintervention after endovascular abdominal aortic aneurysm repair necessitates lifelong surveillance, which has associated costs, radiation exposure, and risk of nephrotoxicity. The best imaging method and timing of surveillance remain controversial. We sought to determine if a negative result of first postoperative imaging by computed tomography (CT) scan was predictive of decreased need for reintervention. We hypothesized that initial negative postoperative imaging could identify a low-risk cohort of patients who could be observed less frequently. Methods Retrospective review of prospectively collected institutional outcomes data (2004-2009) included stratification according to postoperative imaging results. Baseline characteristics and aneurysm morphology were compared between the two groups. Cox regression analysis was used to identify risk factors predictive for endoleak-related reintervention. Kaplan-Meier survival curves were used to plot freedom from all-cause reintervention and endoleak-related reintervention for the two groups. Results A total of 134 patients were included in the analysis. A total of 107 patients (80%) had negative initial postoperative imaging, whereas 27 patients (20%) had evidence of an endoleak. There were no significant differences between the two groups in terms of comorbidities or anticoagulation status. Kaplan-Meier survival curves showed that there was a significant difference between those patients who had a negative initial CT scan and those who had a positive scan for endoleak in terms of both overall reintervention rates and leak-related reintervention rates. Endoleak on the first postoperative CT scan was associated with a hazard ratio of 6.37 (confidence interval, 2.02-20.10; P =.002) for leak-related reintervention and a hazard ratio of 6.01 (confidence interval, 2.24-16.17; P

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