Is There a Benefit of Frequent CT Follow-up After EVAR?
Dias, Nuno LU
; Riva, L
; Ivancev, Krassi
LU
; Resch, Tim
LU
; Sonesson, Björn
LU
and Malina, Martin
LU
(2009)
In European journal of vascular and endovascular surgery
Feb 20.
p.425-430
- Abstract
- OBJECTIVE: Imaging follow-up (FU) after endovascular aneurysm repair (EVAR) is usually performed by periodic contrast-enhanced computed tomography (CT) scans. This study aims to evaluate the effectiveness of CT-FU after EVAR. METHODS: In this study, 279 of 304 consecutive patients (261 male, aged 74 years (interquartile range (IQR): 70-79 years) with a median abdominal aortic aneurysm (AAA) diameter of 58mm (IQR: 53-67mm)) underwent at least one of the yearly CT scans and plain abdominal films after EVAR. All patients received Zenith stent-grafts for non-ruptured AAAs at a single institution. Patients were considered asymptomatic when a re-intervention was done solely due to an imaging FU finding. The data were prospectively entered in a... (More)
- OBJECTIVE: Imaging follow-up (FU) after endovascular aneurysm repair (EVAR) is usually performed by periodic contrast-enhanced computed tomography (CT) scans. This study aims to evaluate the effectiveness of CT-FU after EVAR. METHODS: In this study, 279 of 304 consecutive patients (261 male, aged 74 years (interquartile range (IQR): 70-79 years) with a median abdominal aortic aneurysm (AAA) diameter of 58mm (IQR: 53-67mm)) underwent at least one of the yearly CT scans and plain abdominal films after EVAR. All patients received Zenith stent-grafts for non-ruptured AAAs at a single institution. Patients were considered asymptomatic when a re-intervention was done solely due to an imaging FU finding. The data were prospectively entered in a computer database and retrospectively analysed. RESULTS: As a follow-up, 1167 CT scans were performed at a median of 54 months (IQR: 34-74 months) after EVAR. Twenty-seven patients exhibited postoperative AAA expansion (a 5-year expansion-free rate of 88+/-2%), and 57 patients underwent 78 postoperative re-interventions with a 5-year secondary success rate of 91+/-2%. Of the 279 patients, 26 (9.3%) undergoing imaging FU benefitted from the yearly CT scans, since they had re-interventions based on asymptomatic imaging findings: AAA diameter expansion with or without endoleaks (n=18), kink in the stent-graft limbs (n=4), endoleak type III due to stent-graft limb separation without simultaneous AAA expansion (n=2), isolated common iliac artery expansion (n=1) and superior mesenteric artery malperfusion due to partial coverage by the stent-graft fabric (n=1). CONCLUSIONS: Less than 10% of the patients benefit from the yearly CT-FU after EVAR. Only one re-intervention due to partial coverage of a branch by the stent-graft would have been delayed if routine FU had been based on simple diameter measurements and plain abdominal radiograph. This suggests that less-frequent CT is sufficient in the majority of patients, which may simplify the FU protocol, reduce radiation exposure and the total costs of EVAR. Contrast-enhanced CT scans continue, nevertheless, to be critical when re-interventions are planned. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/1302319
- author
- Dias, Nuno
LU
; Riva, L
; Ivancev, Krassi
LU
; Resch, Tim
LU
; Sonesson, Björn
LU
and Malina, Martin
LU
- organization
- publishing date
- 2009
- type
- Contribution to journal
- publication status
- published
- subject
- in
- European journal of vascular and endovascular surgery
- volume
- Feb 20
- pages
- 425 - 430
- publisher
- Elsevier
- external identifiers
-
- wos:000265199400009
- pmid:19233689
- scopus:61849088425
- pmid:19233689
- ISSN
- 1532-2165
- DOI
- 10.1016/j.ejvs.2008.12.019
- language
- English
- LU publication?
- yes
- id
- f5a41113-3dd9-418c-b4c3-9bbb0848ec8e (old id 1302319)
- alternative location
- http://www.ncbi.nlm.nih.gov/pubmed/19233689?dopt=Abstract
- date added to LUP
- 2016-04-04 09:43:52
- date last changed
- 2022-05-09 06:23:14
@article{f5a41113-3dd9-418c-b4c3-9bbb0848ec8e,
abstract = {{OBJECTIVE: Imaging follow-up (FU) after endovascular aneurysm repair (EVAR) is usually performed by periodic contrast-enhanced computed tomography (CT) scans. This study aims to evaluate the effectiveness of CT-FU after EVAR. METHODS: In this study, 279 of 304 consecutive patients (261 male, aged 74 years (interquartile range (IQR): 70-79 years) with a median abdominal aortic aneurysm (AAA) diameter of 58mm (IQR: 53-67mm)) underwent at least one of the yearly CT scans and plain abdominal films after EVAR. All patients received Zenith stent-grafts for non-ruptured AAAs at a single institution. Patients were considered asymptomatic when a re-intervention was done solely due to an imaging FU finding. The data were prospectively entered in a computer database and retrospectively analysed. RESULTS: As a follow-up, 1167 CT scans were performed at a median of 54 months (IQR: 34-74 months) after EVAR. Twenty-seven patients exhibited postoperative AAA expansion (a 5-year expansion-free rate of 88+/-2%), and 57 patients underwent 78 postoperative re-interventions with a 5-year secondary success rate of 91+/-2%. Of the 279 patients, 26 (9.3%) undergoing imaging FU benefitted from the yearly CT scans, since they had re-interventions based on asymptomatic imaging findings: AAA diameter expansion with or without endoleaks (n=18), kink in the stent-graft limbs (n=4), endoleak type III due to stent-graft limb separation without simultaneous AAA expansion (n=2), isolated common iliac artery expansion (n=1) and superior mesenteric artery malperfusion due to partial coverage by the stent-graft fabric (n=1). CONCLUSIONS: Less than 10% of the patients benefit from the yearly CT-FU after EVAR. Only one re-intervention due to partial coverage of a branch by the stent-graft would have been delayed if routine FU had been based on simple diameter measurements and plain abdominal radiograph. This suggests that less-frequent CT is sufficient in the majority of patients, which may simplify the FU protocol, reduce radiation exposure and the total costs of EVAR. Contrast-enhanced CT scans continue, nevertheless, to be critical when re-interventions are planned.}},
author = {{Dias, Nuno and Riva, L and Ivancev, Krassi and Resch, Tim and Sonesson, Björn and Malina, Martin}},
issn = {{1532-2165}},
language = {{eng}},
pages = {{425--430}},
publisher = {{Elsevier}},
series = {{European journal of vascular and endovascular surgery}},
title = {{Is There a Benefit of Frequent CT Follow-up After EVAR?}},
url = {{https://lup.lub.lu.se/search/files/5402495/1366290.pdf}},
doi = {{10.1016/j.ejvs.2008.12.019}},
volume = {{Feb 20}},
year = {{2009}},
}