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Post-operative Surveillance Of Evar With Computed Tomography Scan Vs Duplex Ultrasonography As Initial Imaging Modality
Aakanksha Gupta, MD, Patrick Conroy, MD, Katherine McMackin, MD, Joseph Lombardi, MD, MBA.
Cooper University Hospital, Camden, NJ, USA.
Introduction: The choice of imaging modality for post-operative surveillance plays a pivotal role in the long-term success of EVAR. Current SVS guidelines recommend surveillance with a Computed Tomography scan (CTS) at one month and further follow-up with a Duplex Ultrasound (DUS) in the absence of an endoleak or sac enlargement. This study delves into the comparative analysis of outcomes when employing CTS versus DUS as the first imaging modality for post-operative EVAR surveillance.
Methods: A retrospective review of patients who underwent an EVAR for an infrarenal abdominal aortic aneurysm was performed between 2010 to 2023 at a single academic center. Patients were stratified based on initial post operative imaging modality, CTS vs DUS. This was dependent on attending preference for follow-up imaging. Primary outcome was re-intervention. Secondary outcomes were mortality and presence of any endoleak. Group 1 was defined as DUS and group 2 as CTS as initial post-operative surveillance modalities respectively. Kaplan Meier curves were plotted for the patients whose mortality dates were known in both groups.
Results: Of the 115 patients surveilled using DUS as initial imaging after EVAR, 15 (13%) had endoleaks detected and 9 patients (7.8%) underwent reintervention. 54 patients had CTS as initial imaging modality with 10 (18.5%) endoleaks detected and 13 (24%) patients underwent re-intervention. No statistically significant difference was observed between the rate of endoleak detection (p=0.23). However, patients surveilled using CTS had a higher rate of re-intervention (p=0.007) (Table 1). No difference in outcomes was observed in the two groups in terms of survival post EVAR (p = 1.0) (Figure 1).
Conclusion: Our study demonstrates that while the rate of re-intervention was higher in patients surveilled using CTS as the initial imaging modality, there was no difference in the rate of endoleak detection. Additionally, there was no survival benefit in patients being surveilled using CTS compared to DUS.
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