Utility Of 30-day Computed Tomography Scan Following Elective Endovascular Aortic Aneurysm Repair
Sarah Budik, MD, Monica O'Brien-Irr, MS, NP, Jack Koenig, Christopher Tanga, DO, Brittany Montross, Sikandar Khan, Hasan Dosluoglu, MD, Linda Harris, MD, Maciej Dryjski, MD, PhD.
University at Buffalo, Buffalo, NY, USA.
Objective: Current guidelines recommend routine 30-day computed tomography (CT) surveillance following endovascular abdominal aortic aneurysm repair (EVAR). Six-month CT surveillance can be eliminated if the 1-month scan shows no concerning endoleak or sac enlargement. We evaluated the utility of skipping the one-month CT and obtaining the initial follow-up CT at one year following EVAR in patients treated within the instruction for use (IFU) and who have normal completion angiogram.
Methods: All elective EVAR at a university affiliated center over a 5-year period were identified. Patient demographics, compliance with graft manufacturer's IFU, operative findings, and follow-up CT results were collected. Compliance with IFU and/or presence of any endoleak on the completion angiogram was correlated with need for re-intervention for repair of endoleak within one year of EVAR.
Results: There were 138 EVARs. Eighty-four (61%) were fully compliant with IFU; 89 (64%) met aortic IFU, 122 (88%) limb IFU. Mean follow-up (FU) was 37 + 22 months. Surveillance CT was available for 125 (91%) with 30-day CT in 89 patients (64%). Intra-operative completion angiogram demonstrated 3 (2.1%) type Ia and 33 (24%) type II endoleaks with no type Ib, III, or IV. The 3 type Ia endoleaks resolved within 2 months of EVAR and occurred in cases not fully compliant with IFU. Forty-five percent of cases were fully compliant with IFU and had no evidence of any endoleak on the intraoperative completion angiogram. Reintervention within 12 months was required in 2 (1.4%) non-IFU compliant cases; one for new type1b endoleak at 2 months and one for symptomatic type II endoleak at 5 months. Reintervention was not required among EVAR completed within IFU without endoleak on intraoperative completion vs non-compliant (0% vs 2.9% P= 0.19) Sensitivity 100%, specificity 46%, NPV 100%.
Conclusions: Reintervention within the first year of EVAR occurred only in those not performed within IFU or with documented endoleak on intraoperative completion angiogram. Using these criteria, initial CT surveillance could be safely delayed to one year in nearly half of EVAR patients while reserving 30-day imaging for those that fail to meet these criteria.
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