Is There a Benefit of Frequent CT Follow-up After EVAR?

Research output: Contribution to journalArticle


title = "Is There a Benefit of Frequent CT Follow-up After EVAR?",
abstract = "OBJECTIVE: Imaging follow-up (FU) after endovascular aneurysm repair (EVAR) is usually performed by periodic contrast-enhanced computed tomography (CT) scans. This study aims to evaluate the effectiveness of CT-FU after EVAR. METHODS: In this study, 279 of 304 consecutive patients (261 male, aged 74 years (interquartile range (IQR): 70-79 years) with a median abdominal aortic aneurysm (AAA) diameter of 58mm (IQR: 53-67mm)) underwent at least one of the yearly CT scans and plain abdominal films after EVAR. All patients received Zenith stent-grafts for non-ruptured AAAs at a single institution. Patients were considered asymptomatic when a re-intervention was done solely due to an imaging FU finding. The data were prospectively entered in a computer database and retrospectively analysed. RESULTS: As a follow-up, 1167 CT scans were performed at a median of 54 months (IQR: 34-74 months) after EVAR. Twenty-seven patients exhibited postoperative AAA expansion (a 5-year expansion-free rate of 88+/-2{\%}), and 57 patients underwent 78 postoperative re-interventions with a 5-year secondary success rate of 91+/-2{\%}. Of the 279 patients, 26 (9.3{\%}) undergoing imaging FU benefitted from the yearly CT scans, since they had re-interventions based on asymptomatic imaging findings: AAA diameter expansion with or without endoleaks (n=18), kink in the stent-graft limbs (n=4), endoleak type III due to stent-graft limb separation without simultaneous AAA expansion (n=2), isolated common iliac artery expansion (n=1) and superior mesenteric artery malperfusion due to partial coverage by the stent-graft fabric (n=1). CONCLUSIONS: Less than 10{\%} of the patients benefit from the yearly CT-FU after EVAR. Only one re-intervention due to partial coverage of a branch by the stent-graft would have been delayed if routine FU had been based on simple diameter measurements and plain abdominal radiograph. This suggests that less-frequent CT is sufficient in the majority of patients, which may simplify the FU protocol, reduce radiation exposure and the total costs of EVAR. Contrast-enhanced CT scans continue, nevertheless, to be critical when re-interventions are planned.",
author = "Nuno Dias and L Riva and Krassi Ivancev and Tim Resch and Bj{\"o}rn Sonesson and Martin Malina",
year = "2009",
doi = "10.1016/j.ejvs.2008.12.019",
language = "English",
volume = "Feb 20",
pages = "425--430",
journal = "European journal of vascular and endovascular surgery",
issn = "1532-2165",
publisher = "Elsevier",