A systematic review of surveillance after endovascular aortic repair

Zaiem, Feras; Almasri, Jehad; Tello, Mouaffaa; Prokop, Larry J.; Chaikof, Elliot L.; Murad, M. Hassan

doi:10.1016/j.jvs.2017.04.058

Cited by 54 publications

(42 citation statements)

References 69 publications

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“…A recently published observational studies–based systematic review by Zaiem et al 23 stated that for surveillance to be justified there needs to be diagnostic accuracy, detection of important prevalent findings, and an effective intervention. Since complications requiring reintervention were observed at all imaging surveillance visits (1, 6, 12, 24, 36, 48, and 60 months) after EVAR, there appeared to be a rationale for standard imaging surveillance.…”

Section: Discussionmentioning

confidence: 99%

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

et al. 2019

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Purpose: To study the effects of imaging surveillance after endovascular aortic repair (EVAR) on reintervention and mortality. Materials and Methods: A systematic review was conducted comparing complication rates in EVAR patients compliant with the imaging surveillance protocol vs partially or noncompliant patients. Two authors independently selected articles and performed quality assessment and data extraction. Risk differences for reintervention and mortality between compliant and partially/noncompliant patients were meta-analyzed. The pooled risk difference (RD) is reported with the 95% confidence interval (CI). The review protocol is registered at Prospero (CRD42017080494). Results: A total of 11 cohort studies involving 21,838 patients were included. Studies differed in imaging, their surveillance protocols, and definitions of compliance subgroups. Median follow-up was 31.7 months (interquartile range 29.8, 49.3). The overall reintervention rate was 5%, while the overall mortality was 31%. The RD for the reintervention rate was 4% (95% CI 1% to 7%) in favor of partial/noncompliance [number needed to harm 25 (95% CI 14 to 100)], while mortality showed a nonsignificant RD of 12% (95% CI −2% to 26%) in favor of partial/noncompliance. Two studies reported that 41% to 53% of reinterventions were performed for complications detected through imaging surveillance; the other events were detected through patient symptoms. Conclusion: Patients who are compliant with imaging surveillance appear to undergo more reinterventions than those who are partially or noncompliant. However, imaging surveillance does not seem to protect against mortality. This suggests that the recommended yearly imaging surveillance may not be beneficial for all EVAR patients.

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Section: Discussionmentioning

confidence: 99%

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

et al. 2019

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“…As endovascular technique and devices are getting improved and indications for EVAR even in complex AAA are expanding, several concerns regarding the length of procedure, radiation hazard, and iodinated contrast agent-induced complications are also increasing. Furthermore, improved survival after EVAR also increased requirement for radiation-based imaging surveillance such as CT angiography for timely detection of EVAR-related complications and for monitoring residual aneurysmal sac (72).…”

Section: Issues Related To Radiation and Contrast Materialsmentioning

confidence: 99%

Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Comprehensive Review

et al. 2019

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Abdominal aortic aneurysm (AAA) can be defined as an abnormal, progressive dilatation of the abdominal aorta, carrying a substantial risk for fatal aneurysmal rupture. Endovascular aneurysmal repair (EVAR) for AAA is a minimally invasive endovascular procedure that involves the placement of a bifurcated or tubular stent-graft over the AAA to exclude the aneurysm from arterial circulation. In contrast to open surgical repair, EVAR only requires a stab incision, shorter procedure time, and early recovery. Although EVAR seems to be an attractive solution with many advantages for AAA repair, there are detailed requirements and many important aspects should be understood before the procedure. In this comprehensive review, fundamental information regarding AAA and EVAR is presented.

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“…However, color Doppler ultrasound is less sensitive than CTA, failing to detect as many as 31% of endoleaks. [5–7] Instead, in 2009, the SVS practice guidelines noted a need for research on defining the role of contrast-enhanced ultrasound (CEUS) in postoperative surveillance. [5] Subsequent meta-analyses and systematic reviews have been performed showing a comparable diagnostic accuracy to CTA in the detection of endoleaks.…”

Section: Introductionmentioning

confidence: 99%

“…However, color Doppler ultrasound can fail to detect as many as 31% of endoleaks. [5–7] Contrast enhanced ultrasound (CEUS) provides an alternative approach to excluded aneurysm sac follow-up imaging. The Society for Vascular Surgery notes a need for further research on the role of CEUS in EVAR surveillance.…”

mentioning

confidence: 99%

A Narrative Review on Contrast-Enhanced Ultrasound in Aortic Endograft Endoleak Surveillance

Gummadi¹,

Eisenbrey

Lyshchik

2018

Ultrasound Quarterly

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Endovascular repair of abdominal aortic aneurysms have been performed successfully since 1991. However, 20% to 50% of these patients may develop an endoleak or continued aneurysmal sac expansion or perfusion despite stent graft coverage. Current recommendations suggest lifelong surveillance with computed tomographic angiography (CTA) at least 1 month after intervention and yearly after that. In select patients with a stable aneurysm sac on computed tomography performed 1 year after treatment, future screening could be performed with ultrasonography. However, color Doppler ultrasound can fail to detect as many as 31% of endoleaks. Contrast-enhanced ultrasound (CEUS) provides an alternative approach to excluded aneurysm sac follow-up imaging. The Society for Vascular Surgery notes a need for further research on the role of CEUS in endovascular aortic repair surveillance. The European Federation of Societies for Ultrasound in Medicine and Biology suggests that early results are promising. Meta-analyses report pooled sensitivities and specificities of CEUS compared with CTA for the detection of endoleak between 89% and 98% and 86% and 88%, respectively. Owing to the dynamic flow information it provides, CEUS may actually be more sensitive than CTA at detection and characterization in select circumstances. Challenges with adoption, patient selection, and operator dependency remain, but current and future research suggests a role for CEUS in endoleak surveillance.

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A systematic review of surveillance after endovascular aortic repair

Abstract: Several tests with reasonable diagnostic accuracy are available for surveillance after EVAR. The available evidence suggests a high complication rate, particularly in the first year, and provides a rationale for surveillance.

Cited by 54 publications

References 69 publications

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

Endovascular Aneurysm Repair for Abdominal Aortic Aneurysm: A Comprehensive Review

A Narrative Review on Contrast-Enhanced Ultrasound in Aortic Endograft Endoleak Surveillance

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