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OBJECTIVES:
Color flow duplex ultrasound (CDU) surveillance is an accepted alternative to computed tomography (CT) following endovascular repair of abdominal aortic aneurysms (EVAR). However, the long term effectiveness and safety of yearly ultrasound-only surveillance is not yet well defined. The purpose of this study was to evaluate the safety and effectiveness of CDU follow-up in the long term.
METHODS:
Patients who underwent EVAR between January 1, 2005 and December 31, 2010, with no routine CT after 1 year and followed with CDU as the primary surveillance method for at least 2 years, were included. Subsequent CT scans were only selectively obtained for enlarging sac size or suspected type I or III endoleak. The majority of type II endoleaks were followed with CDU only.
RESULTS:
169 patients switched to CDU follow-up no later than 1 year after EVAR and followed for 2 to 8 years, with a mean of 4.5 +/- 1.3 years (53.6 +/- 16.1 months) were reviewed. They included 2 patients with limb infolding treated with extra stent grafts and 26 patients with known prior endoleaks detected during the first year, with 2 Type IB and 1 Type II already treated.
During CDU follow-up, 27 patients were identified to have a new endoleak, 7 of whom required a total of 8 re-interventions with endovascular stent graft extension or coiling, 4 after a confirmatory CT and 4 without. One patient with a renal artery stenosis at 3 years underwent angiography and was found to have a renal artery occlusion caused by a barb fracture and migration without endoleak. Only 6 patients underwent a CT to further evaluate findings on CDU.
There were no ruptures, limb occlusions, or AAA-related deaths throughout the period of follow-up.
CONCLUSIONS:
After the 1 year postop CT, a switch to CDU as the primary means of follow-up is a safe and effective surveillance strategy after EVAR.