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J Vasc Surg. 2016 Mar;63(3):589-95. doi: 10.1016/j.jvs.2015.09.021. Epub 2016 Jan 9.

Compliance of postendovascular aortic aneurysm repair imaging surveillance.

Author information

1
Department of Surgery, West Virginia University, Charleston, WVa. Electronic address: ali.aburahma@camc.org.
2
Department of Surgery, West Virginia University, Charleston, WVa.
3
Marshall University, Huntington, WVa.
4
CAMC Health Education and Research Institute, Charleston, WVa.

Abstract

OBJECTIVE:

Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes.

METHODS:

Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months. A Kaplan-Meier analysis was used to compare compliance rates in EVAR patients with hostile neck (HN) vs favorable neck (FN) anatomy (according to instructions for use). A multivariate analysis was also done to correlate compliance and comorbidities.

RESULTS:

Forty-three percent were compliant (7% had no follow-up imaging) and 57% were NC. The mean follow-up for compliant patients was 25.4 months (0-119 months) vs 31.4 months for NC (0-140 months). The mean number of imaging was 3.5 for compliant vs 2.6 for NC (P < .0001). Sixty-four percent were NC for HN patients vs 50% for FN patients (P = .0007). The rates of compliance at 1, 2, 3, 4, and 5 years for all patients were 78%, 63%, 55%, 45%, and 32%; and 84%, 68%, 61%, 54%, and 40% for FN patients; and 73%, 57%, 48%, 37%, and 25% for HN patients (P = .009). The NC rate for patients with late endoleak and/or sac expansion was 58% vs 54% for patients with no endoleak (P = .51). The NC rate for patients with late reintervention was 70% vs 53% for patients with no reintervention (P = .1254). Univariate and multivariate analyses showed that patients with peripheral arterial disease had an odds ratio of 1.9 (P = .0331), patients with carotid disease had an odds ratio of 2 (P = .0305), and HN patients had an odds ratio of 1.8 (P = .0007) for NC. Age and residential locations were not factors in compliance.

CONCLUSIONS:

Overall, compliance of imaging surveillance after EVAR was low, particularly in HN EVAR patients, and additional studies are needed to determine if strict post-EVAR surveillance is necessary, and its effect on long-term clinical outcome.

PMID:
26781078
PMCID:
PMC4985008
[Available on 2017-03-01]
DOI:
10.1016/j.jvs.2015.09.021
[Indexed for MEDLINE]
Free PMC Article

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