Back to 2017 ePosters

OBJECTIVES: After elective endovascular aortic aneurysm repair (EVAR), lifetime surveillance is performed to identify endoleaks and sac enlargement which might lead to rupture. A great deal of cost and patient inconvenience could be avoided if we could identify those patients that do not require routine postoperative imaging. We evaluated EVAR patients in our institution who did not develop an unfavorable imaging characteristic (UIC), endoleak and or sac enlargement, during a minimum 5 year followup. We then attempted to determine which factors might have allowed us to identify these patients preoperatively.
METHODS: We performed a retrospective chart review of all EVAR procedures from 2004 to 2011. Data gathered included patient demographics, and comorbidities, aneurysm characteristics (neck length and angulation, presence of thrombus in the neck and morphology), peri-procedural factors and followup imaging. We divided patients into two groups: 1. Patients who had favorable imaging characteristics, and 2. Patients who developed UIC at any point during follow up. Data was analyzed using chi square, ANCOVA in general lineal model and 2k factorial analysis.
RESULTS: There were 135 EVARs performed in our institution in the study period. Twenty seven patients were excluded. Mean age at time of procedure was 75 (59 - 93), with 90 males (90.5%). Mean followup time was 5.36 years (0.5 - 12). There were 67 patients in group 1 and 40 patients in group 2 UIC included: 35 endoleaks <5 years since initial procedure, 2 Endoleaks >5 years, 3 sack enlargements without endoleak <5 years. There was one mortality. Thirty percent of patients in group 1 and 50% of patients in group 2 had arterial hypertension (HTN) (p=0.037). None of the factors analyzed impacted development of UIC independently. The absence of neck angulation and HTN nearly reached statistical significance in predicting freedom from UIC (p=0.06).
CONCLUSIONS: Lifelong postoperative imaging compromises the cost associated with EVAR. In our study, patients who did not develop endoleaks or sac enlargement, were more often without HTN and had aortic morphology with little or no aortic neck angulation, but this did not reach statistical significance. Further studies involving larger populations of EVAR patients are necessary to identify factors which might indicate the need for less rigorous surveillance. Until then we recommend life time surveillance on all EVAR patients.