Key result
Patients compliant with imaging surveillance after endovascular aneurysm repair had a significantly higher reintervention rate (RD 4%) compared to partially or noncompliant patients, with no significant protective effect against mortality.
Why the study?
To evaluate the effects of imaging surveillance after endovascular aortic repair (EVAR) on reintervention and mortality.
Does compliance with imaging surveillance after EVAR reduce reinterventions and mortality in patients with infrarenal AAA?
Meta-Analysis (n=21,838)
Does compliance with imaging surveillance after EVAR reduce reinterventions and mortality in patients with infrarenal AAA?
Compliance with imaging surveillance after EVAR is associated with more reinterventions but does not appear to protect against mortality, suggesting that routine yearly imaging may not be beneficial for all patients.
Answers are grounded in this paper and cite their sources.
Questions routine post-EVAR surveillance; challenges guidelines and leaves open risk-stratified imaging strategies.
Purpose: To study the effects of imaging surveillance after endovascular aortic repair (EVAR) on reintervention and mortality. Materials and Methods: A systematic review was conducted comparing complication rates in EVAR patients compliant with the imaging surveillance protocol vs partially or noncompliant patients. Two authors independently selected articles and performed quality assessment and data extraction. Risk differences for reintervention and mortality between compliant and partially/noncompliant patients were meta-analyzed. The pooled risk difference (RD) is reported with the 95% confidence interval (CI). The review protocol is registered at Prospero (CRD42017080494). Results: A total of 11 cohort studies involving 21,838 patients were included. Studies differed in imaging, their surveillance protocols, and definitions of compliance subgroups. Median follow-up was 31.7 months (interquartile range 29.8, 49.3). The overall reintervention rate was 5%, while the overall mortality was 31%. The RD for the reintervention rate was 4% (95% CI 1% to 7%) in favor of partial/noncompliance [number needed to harm 25 (95% CI 14 to 100)], while mortality showed a nonsignificant RD of 12% (95% CI −2% to 26%) in favor of partial/noncompliance. Two studies reported that 41% to 53% of reinterventions were performed for complications detected through imaging surveillance; the other events were detected through patient symptoms. Conclusion: Patients who are compliant with imaging surveillance appear to undergo more reinterventions than those who are partially or noncompliant. However, imaging surveillance does not seem to protect against mortality. This suggests that the recommended yearly imaging surveillance may not be beneficial for all EVAR patients.
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Mik et al. (2019) conducted a meta-analysis in Infrarenal abdominal aortic aneurysm post-endovascular aneurysm repair (EVAR) (n=21,838). Compliance with imaging surveillance vs. Partial or noncompliance with imaging surveillance was evaluated on Reintervention rate (RD 4%, 95% CI 1 to 7). Patients compliant with imaging surveillance after endovascular aneurysm repair had a significantly higher reintervention rate (RD 4%) compared to partially or noncompliant patients, with no significant protective effect against mortality.
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