St. George's Vascular Institute Score Evaluated to Predict Reinterventions After EVAR and Open Repair of AAA

June 2, 2016—Jorg Lucas de Bruin, MD, et al of the DREAM (Dutch Randomized Endovascular Aneurysm Management) study group published an investigation of the St. George’s Vascular Institute (SGVI) score to predict reinterventions after open and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA). The study is available in the Journal of Vascular Surgery (JVS, 2016;63:1428–1433).

The goal of this study was to validate the SGVI score to identify patients at risk for a secondary intervention after elective aneurysm repair. Identifying patients at risk for aneurysm rupture and sac expansion after open repair and EVAR of AAA may help to attenuate this risk by intensifying follow-up and early detection of problems.

As summarized in JVS, the investigators performed a post hoc on-treatment analysis of a randomized trial comparing open repair and EVAR of AAA. The multicenter trial randomly assigned 351 AAA patients to undergo open repair or EVAR.

Information on survival and reinterventions was available for all patients at 5 years postoperatively, for 79% at 6 years, and for 53% at 7 years. Open repair was completed in 173 patients and EVAR in 171, based on an on-treatment analysis. Because 17 patients had incomplete anatomic data, 327 patients (157 open repair and 170 EVAR) were available for analysis. During 6 years of follow-up, 78 patients underwent at least one reintervention.

The SGVI score, which is calculated from preoperative AAA morphology using aneurysm and iliac diameter, predictively dichotomized patients into groups at high risk or low risk for a secondary intervention. The observed freedom from reintervention was compared between groups at predicted high risk and low risk.

The investigators reported that the 20 patients in the high-risk group were indeed at higher risk for a secondary intervention compared with the 307 patients predicted to be at low risk (hazard ratio [HR], 3.82; 95% confidence interval [CI], 2.05–7.11; P < .001). Discrimination between high-risk and low-risk groups was valid for EVAR (HR, 4.06; 95% CI, 1.93–8.51; P < .001) and for open repair (HR, 3.41; 95% CI, 1.02–11.4; P = .033).

The SGVI score appears to be a useful tool to predict reintervention risk in patients after open repair and EVAR, concluded the investigators in JVS.

In April 2015, Alan Karthikesalingam, MD, et al published a study providing international validation of the SGVI morphological risk score in the British Journal of Surgery (2015;102:509–515). Those investigators concluded that the SGVI score predicts midterm reinterventions and endograft complications and may enable risk-stratified surveillance after EVAR of AAA.