title: International validation of a risk score for complications and reinterventions after endovascular aneurysm repair.
abstract: BACKGROUND
  Lifelong surveillance is considered mandatory after endovascular repair (EVAR) of abdominal aortic aneurysms to detect endograft complications and prevent aneurysm rupture. Current protocols are not cost-effective or clinically effective. The international validity of the St George's Vascular Institute (SGVI) score for EVAR complications was examined.
  
  
  METHODS
  The ENGAGE registry recruited patients undergoing EVAR at 79 centres in 30 countries. Reinterventions and endograft complications were recorded for up to 3 years after surgery. Preoperative aneurysm morphology was extracted from the registry database, and used to predict whether patients would be at low or high risk of complications after EVAR based on the SGVI score. Kaplan-Meier analysis was used to compare the incidence of endograft complications and reinterventions in patients predicted to be at low risk compared with those predicted to be at high risk.
  
  
  RESULTS
  Some 1207 patients underwent EVAR, with follow-up of up to 3 years. The SGVI score accurately discriminated freedom from reinterventions (90·5 versus 79·3 per cent in low- versus high-risk patients; P < 0·001), freedom from endograft complications (77·9 versus 69·6 per cent in low- versus high-risk patients; P = 0·012), and freedom from a composite outcome measure of reinterventions or endograft complications (75·0 versus 66·1 per cent in low- versus high-risk patients; P = 0·006) during mid-term follow-up.
  
  
  CONCLUSIONS
  This study has provided international validation of a morphological risk score that predicts mid-term reinterventions and endograft complications. The results may enable risk-stratified surveillance after EVAR.
authors.affiliation: Department of Outcomes Research, St George's Vascular Institute, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: A
authors.initials: A
authors.lastname: Vidal-Diez
authors.forename: J L
authors.initials: JL
authors.lastname: De Bruin
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: R J
authors.initials: RJ
authors.lastname: Hinchliffe
authors.forename: I M
authors.initials: IM
authors.lastname: Loftus
authors.forename: P J
authors.initials: PJ
authors.lastname: Holt
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment / Q000379:methods; D014057:Tomography, X-Ray Computed