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The fate of EVAR after 5 years followed with duplex ultrasound
Zachary M. Phillips, MD1, Emilia Krol, MD1, Danielle Pineda, MD2, Keith Calligaro, MD2, Salman Sheikh, B.A.1, Matthew Doherty, MD2, Douglas Troutman, MD2, Alan Dietzek1.
1Danbury Hospital, Danbury, CT, USA, 2Pennsylvania Hospital, Philadelphia, PA, USA.

Introduction: Interventions for sac growth have been reported across multiple time points following endovascular aortic aneurysm repair (EVAR). There are few reports on the long term fate of patients after EVAR followed with duplex with respect to the need for and type of interventions after 5 years.
Methods
We report a series of patients who underwent EVARs at two institutions and were followed for a minimum of five years. All patients were followed with duplex ultrasonography (DU) in our accredited non-invasive vascular laboratories. The type and timing of interventions are noted.
Results:
One-hundred forty-two patients underwent EVAR and were followed for more than five years. Interventions for endoleak or graft limb thrombosis were performed in 37(26%) patients at some time during their follow-up (mean = 7.5 yrs; range 5.1- 14.5 years). Twenty seven (19%) of the 142 patients underwent their first intervention during the first five years of follow-up and the remaining ten (7%) patients underwent a first intervention more than five years after implantation. In these ten patients, intervention was performed for Type I endoleak in 3 patients, Type II endoleak with sac expansion in 3 patients, Type III endoleak in 2 patients (one with rupture), and combined Type I and II endoleaks in 2 patients.
No patient developed a new limb thrombosis after five years of follow-up.
Conclusion
Long-term follow up of EVAR revealed that approximately one of four patients will require an intervention at some point. Interventions for endoleaks and graft limb thrombosis were most common in the first 5 years of EVAR follow-up. The only rupture, however, ,and 7% of first time interventions occurred after 5 years , thus highlighting the need for continued graft surveillance beyond five years.


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