Adequate seal and no endoleak on the first postoperative computed tomography angiography as criteria for no additional imaging up to 5 years after endovascular aneurysm repair

Abstract

Our results suggest that the first postoperative CTA provides important information for risk stratification after endovascular aneurysm repair when the Excluder endoprosthesis is used. In patients with adequate seal and no endoleaks, the risk of aneurysm-related adverse events was significantly reduced, resulting in a large number of unnecessary image examinations. Adjusting the imaging protocol beyond 30 days and up to 5 years, based on individual patients' risk, may result in a more efficient and rational postoperative surveillance.

Iliac Seal Zone Dynamics and Clinical Consequences After Endovascular Aneurysm Repair

“…7 In summary, the length of circumferential apposition between the iliac endograft and the iliac artery wall was measured in a CLL reconstruction (Fig. 3).…”

Postoperative Surveillance and Long-term Outcomes After Endovascular Aneurysm Repair Among Medicare Beneficiaries

“…6,7 Single-center studies 6,7 have been unable to show that patients with incomplete surveillance have poorer outcomes compared with those with complete surveillance. Other publications [8][9][10][11][12][13] argue that less frequent surveillance is sufficient for most patients and that the first postoperative CT scan should be used to stratify patients by risk and adjust surveillance guidelines accordingly. Although noteworthy, these studies were fundamentally limited in that they could not distinguish whether participants were lost to or unavailable for follow up or whether they received care elsewhere.…”

“…Previous studies [9][10][11][12][13] have proposed that long-term surveillance guidelines should be based on risk stratification using clinical indicators, especially because certain preoperative anatomic features, intraoperative findings, and postoperative abnormalities have been associated with adverse outcomes after EVAR. For example, Bastos Gonçalves et al 9 found that a normal result on a postoperative CT scan within 17 days of EVAR significantly reduced the risk for aneurysm-related adverse events during a median follow-up of 4.1 years, thus resulting in a large number of unnecessary imaging events for these lowrisk patients. The authors 9 concluded that the first postoperative CT scan should be used to stratify patients based on risk and that the surveillance guidelines should be adjusted accordingly.…”

“…For example, Bastos Gonçalves et al 9 found that a normal result on a postoperative CT scan within 17 days of EVAR significantly reduced the risk for aneurysm-related adverse events during a median follow-up of 4.1 years, thus resulting in a large number of unnecessary imaging events for these lowrisk patients. The authors 9 concluded that the first postoperative CT scan should be used to stratify patients based on risk and that the surveillance guidelines should be adjusted accordingly. Similarly, another study 19 used data from the US Zenith Endovascular multicenter trial and found that freedom from endoleak at 1 month was highly predictive of reduced aneurysm-related mortality, thus leading the authors to conclude that a new EVAR surveillance regimen based on early outcomes is needed.…”

A Novel methodology for improved imaging analysis pre- and post-EVAR

“…Gonçalves and coworkers showed that short length of apposition (< 10 mm) on the first postoperative CTA scan was associated with AAArelated adverse events. 18 In this study, reduced apposition was not observed on the first postoperative scan, but during later follow-up, which is explained by a difference in patient selection. Gonçalves and coworkers included patients with evident complications on the first postoperative CTA scan, while this study included only patients with at least one postoperative CTA scan without complications.…”