Systematic review of follow-up compliance after endovascular abdominal aortic aneurysm repair

INTRODUCTION: Lifelong surveillance after endovascular aortic aneurysm repair (EVAR) is recommended to monitor the effectiveness and durability of the treatment. The aim of this study was to assess patients' compliance with the follow-up imaging protocol, the presence of any factors associated with compliance and the potential influence of imaging-protocol adherence on outcomes. EVIDENCE ACQUISITION: MEDLINE, EMBASE, and Cochrane Central databases and key references were searched. EVIDENCE SYNTHESIS: One multicenter observational study (registry) and nine retrospective studies were identified reporting on EVAR surveillance compliance. The studies included 36,119 patients with mean age of 76±3.1 years under mean follow-up ranging from 25 to 73 months. Most of them were males (51-89%), white (51-97.7%) and the majority of them were living over 100 miles from the treatment center. The data were too heterogeneous to perform a meta-analysis. Incomplete follow-up and complete loss of follow-up were ranging from 15% to 65% and 22% to 56%, respectively. Advanced age, symptomatic or ruptured aneurysm, history of chronic diseases, and social-economic factors were associated with poor follow-up compliance. Five studies suggested that complete follow-up did not offer any survival benefit, while only one study suggested that incomplete follow-up was associated with higher fatal complication rates. CONCLUSIONS: Patients' compliance with follow-up protocol after EVAR is about 50%. Several factors have been associated with this poor compliance, however there is lack of solid evidence to show that this poor compliance results in worse outcomes. Prospective studies focusing on follow-up adherence are needed in order to evaluate its impact on the outcomes.