Detection of Late Complications After EVAR

This work addressed the occurrence of complications after endovascular aortic aneurysm repair (EVAR) for the treatment of infrarenal abdominal aortic aneurysms in a cohort of 454 patients with a 5.2-year follow-up. About 25% of patients experience complications of some kind. As opposed to other studies, here, the vast majority of those complications were asymptomatic and had to be detected through imaging.

This work also established good agreement between ultrasound and computerized tomography in the identification of clinically relevant complications. In any case, events related with inadequate seal were best observed through computerized tomography, suggesting a significant role of such imaging study in follow-up after EVAR.

Complications were classified depending on whether they were symptomatic or merely detected through imaging (ultrasound or computerized tomography). In a subgroup of patients who underwent both studies within less than 3 months, the kappa coefficient for agreement between both imaging modalities was calculated.

The study included 454 patients who underwent EVAR between 1998 and 2012, with a mean follow-up of 5.2 years. About 26% of patients (n = 118) experienced 176 complications.

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About 60.2% of those complications were asymptomatic and the rest (39.8%), symptomatic.

Over half of patients underwent ultrasound and computerized tomography; the kappa coefficient for clinically significant complications between both modalities was 0.91.

Considering computerized tomography as the gold standard, ultrasound has a sensitivity of 88.8% and a specificity of 99.4% for this type of complications.

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Any complications undetected by computerized tomography were related to distal or proximal inadequate seal. All of them were experienced by patients with hostile anatomy due to short distal or proximal sealing length, and they were diagnosed through the first computerized tomography scan after the procedure.

Conclusion

Approximately a quarter of the patients who undergo EVAR will experience complications over time, the majority of which will be asymptomatic. This underlines the importance of adequate control after the procedure.

Original Title: Detection of Late Complications After Endovascular Abdominal Aortic Aneurysm Repair and Implications for Follow up Based on Retrospective Assessment of a Two Centre Cohort.

Reference: Hassan Baderkhan et al. Eur J Vasc Endovasc Surg, article in press. https://doi.org/10.1016/j.ejvs.2020.02.021.

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