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OBJECTIVES:
Standard post-EVAR surveillance includes CTA at 1, 6, and 12 months. Early CTA exposes the patient to additional radiation and contrast shortly after the EVAR procedure. We hypothesize that routine use of CTA at 1 month does not affect patient outcome and is not justified.
METHODS:
All consecutive patients undergoing EVAR over 6 years (2005-2010) at a tertiary academic center were analyzed for baseline patient and intervention characteristics and surveillance CTA results.
RESULTS:
657 patients underwent EVAR, of which 467 had a 1-month CTA. The median follow-up for these patients was 18.8 months. 354 (76%) of the CTA’s had no EVAR-related abnormality. Endoleaks (93; type I-3, type II-89, type III-1) accounted for the majority of abnormal findings on the remaining CTA’s. All of the type I and III, and 1 of the type II endoleaks were intervened upon based on their identification in asymptomatic patients at 1 month. Importantly, during the index procedure, these patients with type I/III leaks all had adjunctive procedures to assist in obtaining a seal, abnormal completion angiograms, or procedures outside of IFU. The patient with a type II leak had an extremely large AAA. Of patients with type II endoleaks at 1 month without intervention: the median sac growth in the ensuing 5 months was 0 mm; 25% resolved by 6 months, 11% were intervened upon between 6-12 months based on sac enlargement compared to the preprocedural CTA, and the remainder were followed. None resulted in aneurysm rupture or other adverse events during the follow-up period.
CONCLUSIONS:
Abnormal findings during the 1 month CTA are uncommon and if present rarely require intervention. Those that require intervention can be predicted during the index procedure. Abnormalities not requiring intervention typically resolved within 6 months or usually remain benign. Based upon these findings we conclude that the 1 month CTA is unnecessary except under particular circumstances which are clear at the index procedure.