Compliance of postendovascular aortic aneurysm repair imaging surveillance

Abstract

Objective Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes. Methods Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months. A Kaplan-Meier analysis was used to compare compliance rates in EVAR patients with hostile neck (HN) vs favorable neck (FN) anatomy (according to instructions for use). A multivariate analysis was also done to correlate compliance and comorbidities. Results Forty-three percent were compliant (7% had no follow-up imaging) and 57% were NC. The mean follow-up for compliant patients was 25.4 months (0-119 months) vs 31.4 months for NC (0-140 months). The mean number of imaging was 3.5 for compliant vs 2.6 for NC (P< .0001). Sixty-four percent were NC for HN patients vs 50% for FN patients (P = .0007). The rates of compliance at 1, 2, 3, 4, and 5 years for all patients were 78%, 63%, 55%, 45%, and 32%; and 84%, 68%, 61%, 54%, and 40% for FN patients; and 73%, 57%, 48%, 37%, and 25% for HN patients (P = .009). The NC rate for patients with late endoleak and/or sac expansion was 58% vs 54% for patients with no endolcak (P = .51). The NC rate for patients with late reintervention was 70% vs 53% for patients with no reintervention (P = .1254). Univariate and multivariate analyses showed that patients with peripheral arterial disease had an odds ratio of 1.9 (P = .0331), patients with carotid disease had an odds ratio of 2 (P = .0305), and HN patients had an odds ratio of 1.8 (P = .0007) for NC. Age and residential locations were not factors in compliance. Conclusions Overall, compliance of imaging surveillance after EVAR was low, particularly in HN EVAR patients, and additional studies are needed to determine if strict post-EVAR surveillance is necessary, and its effect on long-term clinical outcome.

Endovascular Therapy for Large Vessel Vasculopathy in HIV-infected Patients

“…In general, non-compliant follow-up of patients managed with endovascular therapy for vascular disease, ranging from 32e57%, 32e34 remains a universal problem in South Africa. In addition to HIV co-morbidity and mortality, in developing settings such as ours, geographical location, socioeconomic, financial and human resource constraints and psychosocial issues that are known to impact upon patient follow-up negatively, 32,33 remain unexplored in the context of HIV/AIDS. The poor >30 day patient follow-up in the present study precluded optimal appraisal of long-term outcomes in endovascularly treated patients and the resultant smaller sample for assessing association between cohort, outcome and risk factor was not sufficiently powered, resulting in nonsignificant findings.…”

Nellix stent graft migration after endovascular aneurysm sealing

“…Therefore, lifelong imaging surveillance constitutes an integral part of the management of patients undergoing EVAR [1]. Surveillance modalities include plain radiography, computed tomography, magnetic resonance imaging, ultrasound, and conventional angiography, with inherent advantages and limitations to each [2].…”

Importance of Follow-up Imaging in the Detection of Delayed Type 2 Endoleaks Despite Complete Aneurysmal Sac Shrinkage

“…11 Inaccessible CTA, cost, contrast nephropathy and radiation exposure are among the most notable factors contributing to poor adherence. 12 These two cases demonstrate the likelihood of late sac growth despite significant shrinkage during follow-up. Consequently, even though there is a tendency to reduce imaging after adequate sealing and aneurysmal sac shrinkage is observed, post-EVAR surveillance cannot be completely halted.…”

“…14 This modification in imaging surveillance has been suggested in recent literature, and offers the additional benefit of cost reduction. 12,15…”