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Surveillance of EVAR with Aortic Duplex Ultrasound: Safe after Five Years
Alan M. Dietzek, MD, Emilia Krol, MD, Zachary Phillips, Dahlia Plummer, MD, Richard Hsu, MD.
Danbury Hospital, Danbury, CT, USA.
Objectives:, Aortic duplex ultrasonography (ADU) has emerged as a reasonable alternative to CT for EVAR surveillance. There are, however, few published reports demonstrating the adequacy of ADU for the extended surveillance of EVAR patients. We sought to review the outcomes in our EVAR patients followed for more than 5 years using ADU for surveillance.
Methods: We performed a retrospective chart review of all EVAR cases performed in our institution between 2004 and 2010 so that all patients were followed for 5 or more years. Patients were surveilled with ADU for changes in aneurysm sac size (AnSS) and the presence of endoleaks (EL). A CT was performed only when there was an increase in AnSS of more than 0.5 cm, the presence of Type I or persistent Type II ELs.
Results: 105 EVAR cases were performed in our institution between 2004 and 2010. The mean length of follow up (f/u) was 87 months with a range of 61 to 126 months. Fifty two patients were lost to f/u, relocated or died of non-aneurysm related causes before the 5-year f/u. Nineteen of the remaining 53 patients (28%) required re-intervention at some point during their f/u but none after 5 years. 79% (15/19) of these patients had an increase in AnSS of more than 0.5cm subsequently confirmed by CT scan. All had an EL detected on ADU and CT or CT only. The remaining 4/19 patients had graft limb occlusions requiring intervention. Seven of the 34 patients that did not have an intervention, had an increase in AnSS detected by ADU and CT but without evidence of an EL on ADU and CT or CT alone. In this subset of patients, sac size increase proved to be either transient or without further growth on f/u ADU testing. Over the course of the study period there were no unexpected AAA ruptures.
Conclusion: Long-term f/u of EVAR patients revealed that approximately one in four patients will require re-intervention after EVAR. Our surveillance protocol of obtaining a CT scan only if ADU demonstrated an increase in AnSS proved safe over the long term, with no patients rupturing unexpectedly. Interestingly, none of our patients required intervention after 5 years, which calls into question the need for any surveillance after this time point.
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