individualized follow-up protocol by evaluating patients' follow-up images and comparing reintervention-free survival and rupture rate according to the findings.Methods: Between 2000 and 2010, there were 282 patients with an abdominal aortic aneurysm who underwent elective EVAR. Patients were annually followed up to March 2017. In the beginning of the study, patients were observed annually with computed tomography angiography (CTA). Since 2005, the follow-up protocol changed into annual color duplex ultrasound examination. However, CTA was still performed at 2 years after the primary procedure. All control CTA and color duplex ultrasound examinations were reanalyzed, and patients were categorized into groups according to the presence of any endoleak or sac shrinkage of $5 mm. Kaplan-Meier analysis was performed to identify reintervention-free survival for each group.Results: The median follow-up for the cohort was 78 months (range, 0-201 months), and overall survival at 2 years was 84% (n ¼ 237). Imaging data at 2 years were available for 219 (92%) patients. After the 2-year cutoff point, complication was detected in 21% (n ¼ 45) of patients, the most common being endoleak (13%). Altogether, 19% (n ¼ 45) of the patients still under surveillance required secondary procedures after 2 years. Among patients without detectable endoleak and documented decrease in the maximum aneurysm sac size of $5 mm (n ¼ 137 [63%]) at 2 years, the reintervention-free survival was 95% at 12 years. The figure was 31% among those with either endoleak or no significant sac shrinkage (log-rank, P < .001). Furthermore, there were significantly more late ruptures among those with an endoleak or no detectable sac shrinkage at 2 years compared with their counterparts (eight vs one; P ¼ .005).Conclusions: Patients without endoleak and decrease in the aneurysm sac size $5 mm at 2 years have significantly fewer late reinterventions and ruptures during the long-term follow-up than their counterparts. This finding suggests that in these patients, the follow-up interval can be safely prolonged.
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