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One patient in each of the moderate and major shrinkage groups had subsequent sac growth associated with a persistent, isolated type II endoleak.
No difference was observed in the rate of persistent type II endoleaks for the moderate and major shrinkage groups (6·3 and 5·3 per cent respectively).
These were more frequent in the no shrinkage group than in the moderate and major shrinkage groups (12·7, 9·9 and 4·7 per cent respectively; P = 0·038).
The estimated rate of freedom from secondary intervention 4 years after the index imaging examination (5 years after EVAR) was 76·6 (95 per cent c.i. 70·5 to 82·7), 81·8 (72·2 to 91·4) and 91·6 (85·9 to 97·3) per cent for no, moderate and major shrinkage groups respectively (Fig. 1).
Estimates for rates of freedom of direct or undetermined endoleaks 4 years after the index imaging were 89·4 (95 per cent c.i. 84·1 to 94·6), 90·7 (83·8 to 97·6) and 97·2 (93·9 to 100) per cent for no, moderate and major shrinkage groups respectively (Fig. S2, supporting information).
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As a result, patients with a smaller preoperative AAA were less likely to show sac shrinkage at 1 year, and similarly patients with ruptured AAAs were more likely to be included in the major shrinkage group (as their preoperative maximum AAA diameter was generally greater).
Had patients treated for ruptured AAA been excluded, the proportion of patients with complications in each group would not have differed (13·3 per cent for no shrinkage, 9·3percentnt for moderate shrinkage and 4·5percentnt for major shrinkage).
No shrinkage was an independent risk factor for late complications compared with major shrinkage (hazard ratio (HR) 3·11; P < 0·001).
Patients with no shrinkage had significantly more secondary interventions than those with moderate and major shrinkage (20·8, 12·0 and 6·4 per cent respectively; P < 0·001) (Table 2).
Late direct (or undetermined) endoleaks also occurred less frequently in patients with major shrinkage, but no significant difference was observed for patients with moderate or no shrinkage.
A reduction in AAA diameter of between 5 and 9 mm was categorized as moderate shrinkage, and a reduction of 10 mm or more as major shrinkage.
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