Evaluation of Patient Selection Guidelines for Endoluminal AAA Repair with the Zenith Stent-Graft: The Australasian Experience
Bibliographic record
Abstract
PURPOSE: To review the patient selection guidelines for endovascular repair of abdominal aortic aneurysms (AAA) using the Zenith Endovascular Graft and establish an order of importance for each criterion. METHODS: The Zenith Endovascular Graft Research Database was interrogated for information on 238 patients (209 men; mean age 74.9 +/- 0.9 years, range 50-94) treated with a Zenith bifurcated graft from 1994 to 1998. The common complications of endoluminal AAA repair (endoleak, migration, graft occlusion, graft kinking, conversion, and deployment failure) were analyzed to determine any associations with selection criteria. RESULTS: By 1998, 69% of endograft patients did not meet the recommended guidelines; however, primary and secondary aneurysm exclusion rates were 87% and 94%, respectively. Over a median follow-up of 13.4 months (interquartile range 2.8-24.0), 38 (16%) patients developed 28 (74%) early and 10 (26%) late type-I endoleaks. The endoleak rate in necks < or = 10 mm long was 57% (8/14). Endoleak was associated with a neck contour change >3 mm (p = 0.003) and neck length <20 mm (p = 0.045). The risk of proximal endoleak was 4 times greater if at least one of the proximal neck guidelines was breached; combined guideline deviations of "contour change and large diameter" (p = 0.0004), "contour change and short length" (p = 0.006), "large diameter and short length" (p = 0.01), and "contour change and angle" (p = 0.03) also increased the risk of endoleak. Endograft migration was seen in 10 (4.2%) cases; only neck diameter >28 mm (p = 0.0024) was associated with this complication. CONCLUSIONS: Proximal neck contour, length, and diameter are the most important criteria in terms of endoleak development. Breaching the proximal neck length criterion resulted in a 4-fold increase in endoleak, and combined deviations from the guidelines multiplied the effect. Necks < or = 10 mm long are unsuitable for the standard Zenith graft.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.023 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".