A risk-adjusted and anatomically stratified cohort comparison study of open surgery, endovascular techniques and medical management for juxtarenal aortic aneurysms—the UK COMPlex AneurySm Study (UK-COMPASS): a study protocol

Abstract

IntroductionIn one-third of all abdominal aortic aneurysms (AAAs), the aneurysm neck is short (juxtarenal) or shows other adverse anatomical features rendering operations more complex, hazardous and expensive. Surgical options include open surgical repair and endovascular aneurysm repair (EVAR) techniques including fenestrated EVAR, EVAR with adjuncts (chimneys/endoanchors) and off-label standard EVAR. The aim of the UK COMPlex AneurySm Study (UK-COMPASS) is to answer the research question identified by the National Institute for Health Research Health Technology Assessment (NIHR HTA) Programme: ‘What is the clinical and cost-effectiveness of strategies for the management of juxtarenal AAA, including fenestrated endovascular repair?’Methods and analysisUK-COMPASS is a cohort study comparing clinical and cost-effectiveness of different strategies used to manage complex AAAs with stratification of physiological fitness and anatomical complexity, with statistical correction for baseline risk and indication biases. There are two data streams. First, a stream of routinely collected data from Hospital Episode Statistics and National Vascular Registry (NVR). Preoperative CT scans of all patients who underwent elective AAA repair in England between 1 November 2017 and 31 October 2019 are subjected to Corelab analysis to accurately identify and include every complex aneurysm treated. Second, a site-reported data stream regarding quality of life and treatment costs from prospectively recruited patients across England. Site recruitment also includes patients with complex aneurysms larger than 55 mm diameter in whom an operation is deferred (medical management). The primary outcome measure is perioperative all-cause mortality. Follow-up will be to a median of 5 years.Ethics and disseminationThe study has received full regulatory approvals from a Research Ethics Committee, the Confidentiality Advisory Group and the Health Research Authority. Data sharing agreements are in place with National Health Service Digital and the NVR. Dissemination will be via NIHR HTA reporting, peer-reviewed journals and conferences.Trial registration numberISRCTN85731188.

The effect of white blood cell and platelet values on mortality in patients with abdominal aortic aneurysm

“…This period. Female patients were approximately 7 days [17.5 (10-22.25) -11 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)] and were hospitalized longer than males (p=0.016) (Table 1). There was a very weak negative correlation between hospitalization times and hemoglobin and platelet values, and a weak positive correlation between MPV and RDW*MPV values (r=-0.24, p=0.043, r=-0.24, p=0.044, r=0.30, p).…”

“…While the risk of rupture is quite low in small AAAs, it is higher in large AAAs [7]. There are two main methods for the management of AAAs, open surgery and endovascular aneurysm repair (EVAR) [6,8]. Despite new procedures, mortality in FMF remains high despite improved therapies [9].…”

Systematic review of the results of fenestrated endovascular aortic repair in octogenarians

“…The results of FEVAR specifically in juxtarenal aneurysms are currently being evaluated in the UK-COMPASS trial and more data on octogenarians included in this study will further enrich our understanding. 25 …”