National Numbers of Secondary Aortic Reinterventions after Primary Abdominal Aortic Aneurysm Surgery from the Dutch Surgical Aneurysm Audit.
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal
/ diagnostic imaging
Blood Vessel Prosthesis Implantation
/ adverse effects
Endovascular Procedures
/ adverse effects
Female
Humans
Male
Medical Audit
Netherlands
Postoperative Complications
/ mortality
Registries
Reoperation
/ adverse effects
Risk Factors
Time Factors
Treatment Outcome
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
17
02
2020
revised:
29
03
2020
accepted:
07
04
2020
pubmed:
27
4
2020
medline:
11
11
2020
entrez:
27
4
2020
Statut:
ppublish
Résumé
Long-term secondary aortic reinterventions (SARs) can be a sign of (lack of) effectiveness of abdominal aortic aneurysm (AAA) surgery. This study provides insight into the national number of SARs after primary AAA repair by endovascular aneurysm repair (EVAR) or by open surgical repair in the Netherlands. Observational study included all patients undergoing SAR between 2016 and 2017, registered in the compulsory Dutch Surgical Aneurysm Audit (DSAA). The DSAA started in 2013, SARs are registered from 2016. Characteristics of SAR and postoperative outcomes (mortality/complications) were analyzed, stratified by urgency of SAR. Data of SARs were merged with data of their preceded primary AAA repair, registered in the DSAA after January 2013. In these patients undergoing SAR, treatment characteristics of the preceded primary AAA repair were additionally described, with focus on differences between stent grafts. Between 2016 and 2017, 691 patients underwent SAR, this concerned 9.3% of all AAA procedures (infrarenal/juxtarenal/suprarenal) in the Netherlands (77% elective/11% acute symptomatic/12% ruptured). Endoleak (60%) was the most frequent indication for SAR. SARs were performed with EVAR in 66%. Postoperative mortalities after SAR were 3.4%, 11%, and 29% in elective, acute symptomatic, and ruptured patients, respectively. In 26% (n = 181) of the patients undergoing SAR their primary AAA repair was performed after January 2013 and data of primary and SAR procedures could be merged. In 93% (n = 136), primary AAA repair was EVAR. Endografts primarily used were nitinol/polyester (62%), nitinol/polytetrafluoroethylene (8%), endovascular sealing (21%), and others (9%), compared with their national market share of 76% (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.38-0.71), 15% (OR, 0.50; CI, 0.29-0.89), 4.9% (OR, 5.04; CI, 3.44-7.38), and 4.1% (OR, 2.81; CI, 1.66-4.74), respectively. In the Netherlands, about one-tenth of the annual AAA procedures concerns an SAR. A quarter of this cohort had an SAR within 1-5 years after their primary AAA repair. Most SARs followed after primary EVAR procedures, in which an overrepresentation of endovascular sealing grafts was seen. Postoperative mortality after SAR is comparable with primary AAA repair.
Sections du résumé
BACKGROUND
BACKGROUND
Long-term secondary aortic reinterventions (SARs) can be a sign of (lack of) effectiveness of abdominal aortic aneurysm (AAA) surgery. This study provides insight into the national number of SARs after primary AAA repair by endovascular aneurysm repair (EVAR) or by open surgical repair in the Netherlands.
METHODS
METHODS
Observational study included all patients undergoing SAR between 2016 and 2017, registered in the compulsory Dutch Surgical Aneurysm Audit (DSAA). The DSAA started in 2013, SARs are registered from 2016. Characteristics of SAR and postoperative outcomes (mortality/complications) were analyzed, stratified by urgency of SAR. Data of SARs were merged with data of their preceded primary AAA repair, registered in the DSAA after January 2013. In these patients undergoing SAR, treatment characteristics of the preceded primary AAA repair were additionally described, with focus on differences between stent grafts.
RESULTS
RESULTS
Between 2016 and 2017, 691 patients underwent SAR, this concerned 9.3% of all AAA procedures (infrarenal/juxtarenal/suprarenal) in the Netherlands (77% elective/11% acute symptomatic/12% ruptured). Endoleak (60%) was the most frequent indication for SAR. SARs were performed with EVAR in 66%. Postoperative mortalities after SAR were 3.4%, 11%, and 29% in elective, acute symptomatic, and ruptured patients, respectively. In 26% (n = 181) of the patients undergoing SAR their primary AAA repair was performed after January 2013 and data of primary and SAR procedures could be merged. In 93% (n = 136), primary AAA repair was EVAR. Endografts primarily used were nitinol/polyester (62%), nitinol/polytetrafluoroethylene (8%), endovascular sealing (21%), and others (9%), compared with their national market share of 76% (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.38-0.71), 15% (OR, 0.50; CI, 0.29-0.89), 4.9% (OR, 5.04; CI, 3.44-7.38), and 4.1% (OR, 2.81; CI, 1.66-4.74), respectively.
CONCLUSIONS
CONCLUSIONS
In the Netherlands, about one-tenth of the annual AAA procedures concerns an SAR. A quarter of this cohort had an SAR within 1-5 years after their primary AAA repair. Most SARs followed after primary EVAR procedures, in which an overrepresentation of endovascular sealing grafts was seen. Postoperative mortality after SAR is comparable with primary AAA repair.
Identifiants
pubmed: 32335253
pii: S0890-5096(20)30353-8
doi: 10.1016/j.avsg.2020.04.034
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
234-244Investigateurs
P J Van den Akker
(PJ)
G J Akkersdijk
(GJ)
G P Akkersdijk
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W L Akkersdijk
(WL)
M G van Andringa de Kempenaer
(MG)
C H Arts
(CH)
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O J Bakker
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R Balm
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W B Barendregt
(WB)
J A Bekken
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M H Bender
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B L Bendermacher
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M van den Berg
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P Berger
(P)
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(JD)
R J Bleker
(RJ)
J J Blok
(JJ)
A S Bode
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M E Bodegom
(ME)
K E van der Bogt
(KE)
A P Boll
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M H Booster
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B L Borger van der Burg
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G J de Borst
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D H Burger
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H C Buscher
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E Cancrinus
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P H Castenmiller
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G Cazander
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A M Coester
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I Dawson
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(ML)
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(MK)
M Dirven
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R C van Doorn
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L M van Dortmont
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J W Drouven
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M M van der Eb
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D Eefting
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G J van Eijck
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J W Elshof
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B H Elsman
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A van der Elst
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M I van Engeland
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R G van Eps
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M J Faber
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B Fioole
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P P Hedeman Joosten
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L G van der Hem
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J M Hendriks
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K M Huntjens
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M M Idu
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M J Jacobs
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M F van der Jagt
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J R Jansbeken
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R J Janssen
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H H Jiang
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T A Jongbloed-Winkel
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V Jongkind
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M R Kapma
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B P Keller
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A Khodadade Jahrome
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J K Kievit
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P L Klemm
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L van der Laan
(L)
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D A Legemate
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(VJ)
M S Lemson
(MS)
M M Lensvelt
(MM)
M A Lijkwan
(MA)
R C Lind
(RC)
F T van der Linden
(FT)
P F Liqui Lung
(PF)
M J Loos
(MJ)
M C Loubert
(MC)
K M van de Luijtgaarden
(KM)
D E Mahmoud
(DE)
C G Manshanden
(CG)
E C Mattens
(EC)
R Meerwaldt
(R)
B M Mees
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(GC)
T P Menting
(TP)
R Metz
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M J Morak
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R H van de Mortel
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W Mulder
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S K Nagesser
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V J Noyez
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A G Peppelenbosch
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A Rijbroek
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M J van Rijn
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R A de Roo
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E V Rouwet
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B R Saleem
(BR)
P B Salemans
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M R van Sambeek
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M G Samyn
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H P Van't Sant
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J van Schaik
(J)
P M van Schaik
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D M Scharn
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M R Scheltinga
(MR)
A Schepers
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P M Schlejen
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F J Schlosser
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F P Schol
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V P Scholtes
(VP)
O Schouten
(O)
M A Schreve
(MA)
G W Schurink
(GW)
C J Sikkink
(CJ)
A Te Slaa
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H J Smeets
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L Smeets
(L)
R R Smeets
(RR)
A A de Smet
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P C Smit
(PC)
T M Smits
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M G Snoeijs
(MG)
A O Sondakh
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M J Speijers
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T J van der Steenhoven
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S M van Sterkenburg
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D A Stigter
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R P Strating
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G N Stultiëns
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M Teraa
(M)
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(MJ)
T Tha-In
(T)
R M The
(RM)
W J Thijsse
(WJ)
I Thomassen
(I)
I F Tielliu
(IF)
R B van Tongeren
(RB)
R J Toorop
(RJ)
E Tournoij
(E)
M Truijers
(M)
K Türkcan
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R P Tutein Nolthenius
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Ç Ünlü
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R H Vaes
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A A Vafi
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A C Vahl
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E J Veen
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H T Veger
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M G Veldman
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S Velthuis
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H J Verhagen
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B A Verhoeven
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C F Vermeulen
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E G Vermeulen
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R J van der Vijver-Coppen
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R Wouda
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O Yazar
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K K Yeung
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C J Zeebregts
(CJ)
M L van Zeeland
(ML)
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