Unit:
Τομέας ΧειρουργικήςLibrary of the School of Health Sciences
Author:
Dasteridou Theodora
Dissertation committee:
Ανδρέας Μ. Λάζαρης, Αν. Καθηγητής, Ιατρική, ΕΚΠΑ, Επιβλέπων
Αναστάσιος Μαχαίρας, Καθηγητής, Ιατρική, ΕΚΠΑ
Γεώργιος Γερουλάκος, Καθηγητής, Ιατρική, ΕΚΠΑ
Σπυρίδων Βασδέκης, Καθηγητής, Ιατρική, ΕΚΠΑ
Χρήστος Κλωνάρης, Καθηγητής, Ιατρική, ΕΚΠΑ
Σωτήριος Γεωργόπουλος, Καθηγητής, Ιατρική, ΕΚΠΑ
Ιωάννης Κακίσης, Καθηγητής, Ιατρική, ΕΚΠΑ
Original Title:
Μελέτη ενδοδιαφυγής τύπου ΙΙ μετά από ενδαγγειακή αποκατάσταση ανευρυσμάτων κοιλιακής αορτής
Translated title:
Preoperative prediction of type II endoleak following standard EVAR
Summary:
Introduction: Type 2 endoleak (T2EL) consists the main complication after the endovascular repair of an abdominal aortic aneurysm (EVAR). In standard EVARs this may be found in about 1/5 of patients. Although it is considered a benign condition, aortic sac expansion is possible, and this is the reason to keep these patients under close surveillance. Various attempts to identify predictors of T2EL have been made but there is not robust evidence until now. Aim of the study was to identify these parameters and create a risk-scoring model.
Patients and Methods: A prospective clinical study was made. All patients who underwent an EVAR throughout a 12-month period in two large hospitals in Athens, were included. The patients were followed for another 12 months following a prespecified protocol. Various clinical, anatomical and device specific parameters were examined as potential factors of T2EL using univariable and multivariable analysis.
Results: Overall, 73 patients were included. Three patients were excluded due to the development of type 1 endoleak. From the rest 70 patients, 17 (24.3%) developed a T2EL this group consisting the Endoleak group. These patients were compared to those who did not develop T2EL (N=53). The univariable and multivariable analysis demonstrated that three parameters were related with the development of T2EL: the preoperative anticoagulant treatment, the number of patent lumbar arteries in the preoperative CT scan, and the nitinol skeleton of the endograft. Based on the multivariate analysis, the ABS_10 risk scoring system for the preoperative prediction of a T2EL was created as following: 4 points for prior chronic use of Anticoagulants, 1 point for each patent arterial Branch from the aneurysm sac, and 5 points for a nitinol endograft Skeleton, a score higher than 7 presented sensitivity 88%, specificity 62%, positive predictive value 43%, and negative predictive value 94%.
Conclusions: A prediction risk scoring system for the prediction of T2EL after a standard EVAR was created. A score of 7 or less practically excludes the possibility of T2EL. External validation in larger scale populations is needed.
Main subject category:
Health Sciences
Keywords:
Abdominal aortic aneurysm, Type 2 endoleak, Endovascular repair
Number of references:
207
