Surveillance after EVAR: When and How Long

It has been suggested that surveillance after endovascular abdominal aorta aneurysm repair (EVAR) should be for life, seeing as on one hand we are not sure how long these devices last (and they keep coming out), and on the other hand, there could be late complications, such as type 2 leaks. This is why the Health Research Health Technology Appraisals in the UK suggests life-long follow-up.

El tratamiento endovascular parece superior a la cirugía en aneurismas rotosDespite post EVAR surveillance is mandatory in the UK, many recent small or single-center studies suggest patients fail to comply, and there are different data on this regard.

 

This study examines post EVAR follow up compliance and its impact on reintervention and survival rates.

 

It included 1414 patients from 10 centers. By the end of the study, 378 patients had completed a 5-year follow-up that could be looked into.


Read also: In-Hospital Costs and Costs of Complications of Chronic Total Occlusions.


Globally, surveillance compliance was 66% (61-68%) but there was enormous variation between the different centers (between 9% and 88%).

 

Age (HR 1.03, CI 95% 1.01 to 1.05; p=0.02) and distance from hospital (HR 1.01, CI 95% 1.00 to 1.01; p<0.001) were independent predictors of inadequate monitoring.


Read also: We Must Still Fear the “Big Five Complications” After TAVR.


Non-compliant patients showed lower all-cause mortality 3 years after EVAR, while compliant patients showed lower mortality between years 4 and 5 (p<0.001). There were no significant differences in reintervention rate between compliant and non-compliant patients.

 

Conclusion

A great proportion of patients did not comply with recommended post EVAR follow-up protocols. Observed benefits after 3 years seems to correlate with surveillance compliance and therefore surveillance protocols should be followed by patients.

 

Original title: Multicentre Post-EVAR Surveillance Evaluation Study (EVAR-SCREEN).

Reference: Matthew J. Grima et al.


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