Endovascular aortic aneurysm repair surveillance may not be necessary for the first 3 years after an initially normal duplex postoperative study

Troutman, Douglas A.; Chaudry, Mohammed; Dougherty, Matthew J.; Calligaro, Keith D.

doi:10.1016/j.jvs.2014.03.278

Cited by 24 publications

(19 citation statements)

References 15 publications

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“…17,19 Until more data are forthcoming with respect to the revised IFU for the Endologix Powerlink and AFX platforms, the current study strongly suggests that patients treated under the old IFU before 2013 should be restudied annually by CT scan. Studies are now underway investigating post-EVAR surveillance with combined biplane abdominal X-ray and duplex ultrasound imaging to reduce long-term radiation and contrast exposure.…”

Section: Discussionmentioning

confidence: 91%

“…The 2.4% incidence of type IIIa endoleaks reported here is comparable to that of recent studies using Endologix and other modular endografts, which found a 2% to 2.7% long-term incidence of type III endoleaks across multiple endograft platforms. 14,17 In a recent detailed analysis of 108 patients treated with Endologix AFX endograft, Welborn et al 18 reported a 2.3% incidence of type IIIa endoleaks. In addition, independent core laboratory data extracted from two recently presented, but as yet unpublished studies, of the Endologix AFX system by Motaganahalli et al and Arthurs et al found four type IIIa endoleaks in 127 combined patients (3.1%) monitored an average of 10 months after elective EVAR.…”

Section: Discussionmentioning

confidence: 99%

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Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms

Skibba

Evans

Greenfield

et al. 2015

Journal of Vascular Surgery

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Although a small number of secondary interventions were needed after EVAR with the Endologix Powerlink or AFX endografts, most were undertaken for late main-body component uncoupling and type IIIa endoleak, which can occur after sideways displacement of the endograft in large and angulated AAAs. Patients treated before 2013 under the old instructions for use should be evaluated for signs of impending component separation and monitored annually, noting that expected indicators of endograft failure, such as increasing AAA diameter and endoleak, may be absent.

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Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms

Skibba

Evans

Greenfield

et al. 2015

Journal of Vascular Surgery

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“…They observed a 2.4% long-term incidence of type IIIa endoleak which is comparable to other smaller reports over various EVAR platforms. 7,8 However, the incidence of those experiencing modular migration without endoleak remained unclear. 9 Additionally, the true incidence of clinically significant type IIIa endoleaks may be much higher.…”

Section: Discussionmentioning

confidence: 99%

Aggressive Surveillance Is Needed to Detect Endoleaks and Junctional Separation between Device Components after Zenith Fenestrated Aortic Reconstruction

Wang

Lemmon

Gupta

et al. 2019

Annals of Vascular Surgery

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Junctional separation and resulting type IIIa endoleak is a well-known problem after EVAR (endovascular aneurysm repair). This complication results in sac pressurization, enlargement, and eventual rupture. In this manuscript, we review the incidence of this late finding in our experience with the Cook Zenith Fenestrated endoprosthesis (ZFEN, Bloomington, IN) Methods: A retrospective review was performed of a prospectively maintained institutional ZFEN FEVAR (fenestrated EVAR) database capturing all ZFENs implanted at a large-volume, academic hospital system. Patients who experienced junctional separation between the fenestrated main body and distal bifurcated graft (with or without type IIIa endoleak) at any time after initial endoprosthesis implantation were subject to further evaluation of imaging and medical records to abstract clinical courses. Results: In 110 ZFENs implanted from October 2012 to December 2017 followed for a mean of 1.5 years, we observed a 4.5% and 2.7% incidence of clinically significant junctional separation and type IIIa endoleak, respectively. Junctional separation was directly related to concurrent type Ib endoleak in all five patients. Three patients presented with sac enlargement. One patient did not demonstrate any evidence of clinically significant endoleak and had a decreasing sac size during follow-up imaging. The mean time to diagnosis of modular separation in these patients was 40 months. Junctional separation was captured in surveillance in two patients and reintervened upon before manifestation of endoleak. However, the remaining three patients completed modular separation resulting in rupture and emergent intervention in two and an aortic-related mortality in the other. Conclusions: Junctional separation between the fenestrated main and distal bifurcated body with the potential for type IIIa endoleak is an established complication associated with the ZFEN platform. Therefore, we advocate for maximizing aortic overlap during the index procedure followed by aggressive surveillance and treatment of stent overlap loss captured on imaging.

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“…1 Of those who undergo EVAR, 13% to 22% will require reintervention. 2,3 A short infrarenal neck, neck angulation of >45°, and large aortic neck (>28 mm) are predictors of reintervention, 4,5 and large aneurysms (>6.5 cm diameter) and postdeployment migration are poor prognostic signs and associated with increased rates of aneurysm-related morbidity. 6,7 Thus, certain subsets of patients would particularly benefit from effective post-EVAR surveillance, and it is our contention that patients with HN anatomy, defined by neck length of <10 mm, neck angle of 60°, ≥50% circumferential proximal neck thrombus (≥2 mm thick), ≥50% circumferential calcified proximal neck, reverse taper, or a diameter >31 mm, should strictly adhere to surveillance protocols.…”

Section: Discussionmentioning

confidence: 99%

“…1 Of patients who undergo EVAR, 13% to 22% require reintervention. 2,3 Several studies have compared different aspects of aortic neck morphology as a predictor of outcome after EVAR. Aortic neck angulation of >45°, a short infrarenal neck, a large aortic neck, and large aneurysms (>6.5 cm in diameter) are predictors of reintervention 4,5 and associated with increased rates of aneurysm-related morbidity.…”

mentioning

confidence: 99%

Compliance of postendovascular aortic aneurysm repair imaging surveillance

AbuRahma

Yacoub

Hass

et al. 2016

Journal of Vascular Surgery

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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.

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Endovascular aortic aneurysm repair surveillance may not be necessary for the first 3 years after an initially normal duplex postoperative study

Abstract: These findings suggest that follow-up DU surveillance can be postponed until 3 years after EVAR if the initial result of surveillance DU is normal (no endoleak, sac enlargement, stenosis), with minimal risk of an adverse clinical event.

Cited by 24 publications

References 15 publications

Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms

Management of late main-body aortic endograft component uncoupling and type IIIa endoleak encountered with the Endologix Powerlink and AFX platforms

Aggressive Surveillance Is Needed to Detect Endoleaks and Junctional Separation between Device Components after Zenith Fenestrated Aortic Reconstruction

Compliance of postendovascular aortic aneurysm repair imaging surveillance

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