Safety And Utility Of Duplex Us As Sole Initial Modality For Surveillance Following EVAR
Krunal Shukla, BS, Morgan S. Messner, ANP, Francisco Albuquerque, Jr., MD, Robert A. Larson, MD, Daniel H. Newton, MD, Michael F. Amendola, MD, Kedar S. Lavingia, MD, Mark M. Levy, MD.
Virginia Commonwealth University, Richmond, VA, USA.
OBJECTIVES: Post-EVAR surveillance with CTA remains common practice, per SVS guidelines. Chronic exposure to both radiation and IV contrast has raised concerns about long-term CT follow-up. As we have selectively used US as a sole modality for post-EVAR surveillance, we sought to review our outcomes in this subset of patients. METHODS: Retrospective review of our institution’s Vascular Database identified 213 EVAR patients from 2013 to 2021. FEVAR and snorkel reconstructions were excluded. Patient demographics/outcomes, AAA characteristics, and follow-up (FU) modalities and outcomes were analyzed. Student T-test was used for analysis of means. RESULTS: Eighty five of the 213 EVAR patients (39.9%) were lost to FU within 3 months. Among the 128 remaining patients, 91 underwent FU using initial US, while 37 patients underwent post-EVAR FU initially using CTA (see Figure). 
There were no significant differences (p > 0.05) between patient age (75.5 ± 9.4 vs. 75.3 ± 8.5), BMI (27.7 ± 5.4 vs. 28.9 ± 7.4), or mean AAA size (5.6 ± 1.1 vs. 5.9 ± 1.2) in US-surveilled and CT-surveilled groups respectively.
Of the 91 patients initially surveilled with US, 15 patients demonstrated endoleak and/or AAA growth (>5 mm). The 15 patients with US demonstrated-endoleak and/or growth underwent confirmatory CTA with 3 patients requiring EVAR revision. Among 37 patients initially surveilled with CT, 10 demonstrated significant growth and 2 patient required EVAR revision. There were no patients with AAA rupture during post-EVAR surveillance. Follow-up data was analyzed among a select lower risk group of patients (pre-operative AAA diameter ≤ 5.5 cm, BMI ≤ 30, no endoleak at completion of EVAR). Among this group, there were no surveilled patients that required EVAR reintervention regardless of surveillance modality (US n=41; CT n=12). Average follow-up was 29.5 ± 26.4 months in US group and 26.4 ± 22.3 months in CT group (p > 0.05).
CONCLUSIONS: Although CT surveillance following EVAR remains ideal, in select lower risk patients, ultrasound is a viable alternative even for the initial post-procedure study. Advantages include decreased radiation exposure and cost. Our data suggests that US is a safe sole modality for surveillance following EVAR in selective patients.
Back to 2022 ePosters