Key result
A duplex ultrasound-based follow-up program after EVAR detected a higher 5-year rate of endoleaks compared to a historical CT-based program (43.3% vs 34.5%, P<0.001), but fewer endoleaks required reintervention.
Why the study?
Does a DUS-based follow-up program safely identify endoleaks and prevent complications compared to a CT-based program in patients after EVAR?
Cohort (n=843)
No
Does a DUS-based follow-up program safely identify endoleaks and prevent complications compared to a CT-based program in patients after EVAR?
Absolute Event Rate: 43.3% vs 34.5%
p-value: p=<0.001
A DUS-based follow-up program after EVAR is as sensitive as a CT-based program in identifying clinically significant endoleaks, supporting a shift towards less radiation-intensive and more cost-effective surveillance.
Aim: To analyze the results of a follow-up program after endovascular repair of abdominal aortic aneurysm (EVAR) mainly based on duplex ultrasound (DUS) examinations. Materials and methods: The postoperative surveillance program changed over the time. In recent years (2007-2012) we are used to performing a DUS and an angio-CT scan within one month after EVAR, a DUS at 6 and 12 months and every 6 months thereafter (Group 2, 498 interventions). Data were compared with our historical series (2000-2006; Group 1, 345 interventions.) Perioperative results were recorded. The long-term results were analysed by Kaplan-Meier curves. Results: The rates of perioperative mortality were 1.1% and 1.2% respectively ( P =0.9). The cumulative rates of perioperative complications were 16% and 6.5%, respectively ( P =0.001). The rate of reinterventions at 60 months was significantly higher in group 2 than in group 1 (29.1% and 20.1% respectively, P =0.03, log rank 4.6). Also the 5-year rate of endoleak was significantly greater in group 2 than group 1 (43.3% and 34.5% respectively, P <0.001, log rank 13.4); however, the rate of endoleaks requiring a redo procedure was lower in group 2 (35/163, 21.5%) than in group 1 (51/108, 47%; P <0.001). Conclusion: Data from our study confirm that a DUS-based follow-up program in patients undergoing EVAR is equally sensitive in identifying endoleaks to the CT scan-based program used in past years.
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Pulli et al. (2014) conducted a cohort in Abdominal aortic aneurysm (post-EVAR) (n=843). Duplex ultrasound (DUS)-based follow-up program vs. Angio-CT scan-based follow-up program (historical series) was evaluated on 5-year rate of endoleak (p=<0.001). A duplex ultrasound-based follow-up program after EVAR detected a higher 5-year rate of endoleaks compared to a historical CT-based program (43.3% vs 34.5%, P<0.001), but fewer endoleaks required reintervention.
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