Compliance with follow-up after endovascular aneurysm repair

Endovascular abdominal aortic aneurysm repair (EVAR) has become the dominant modality for abdominal aortic aneurysm (AAA) management, accounting for approximately 80% of repairs in the United States, and as such, the burden of post-EVAR surveillance has increased concomitantly. As the risk of late device-related complications following EVAR persists indefinitely, guidelines uniformly highlight the importance of lifelong surveillance, traditionally consisting of computed tomography angiography (CTA) at 1 month, 6 months, 1 year, and annually thereafter. More recently, however, the optimal post-EVAR surveillance regimen has become a subject of considerable debate, driven in part by an emerging body of evidence suggesting that intensive surveillance protocols may prompt prophylactic reinterventions of uncertain clinical benefit, while simultaneously raising concerns regarding long-term cost-effectiveness, cumulative radiation exposure, and the risk of contrast-induced nephrotoxicity. In light of these concerns, and in the absence of high-quality randomized data, guidelines from major vascular societies have diverged in their recommendations and have attempted adopt risk-stratified surveillance paradigms. Nonetheless, even in the context of these less intensive regimens, observational studies reveal that surveillance compliance rates remain substantially low. As such, understanding the determinants of non-compliance, its clinical consequences, and strategies to improve adherence represents an increasingly critical priority in the long-term management of EVAR patients. In this review, we will describe the existing data informing surveillance practices, the impact of non-adherence to recommended surveillance, and remaining unanswered questions in contemporary practice.