What Is The Clinical Utility Of A Six-Month CT In The Follow-Up Of Endovascular Aneurysm Repair Patients?

Michael R. Go, Joel E. Barbato, Michel S. Makaroun.
University of Pittsburgh Medical Center, Pittsburgh, PA.

OBJECTIVES: A drawback of endovascular aneurysm repair (EVAR) is the need for rigid, ongoing postoperative surveillance. Follow-up schedules including one-, six-, and 12-month CT established during regulatory trials have been carried into clinical practice without critical assessment. With the current recommendation to treat type 2 endoleaks only if associated with sac growth, the utility of a six-month CT, with its associated radiation exposure and contrast toxicity, after a normal one-month CT has not been established.

METHODS: Consecutive patients undergoing EVAR from 1996 to 2004 and with complete one-year follow-up were reviewed for clinically significant CT findings at various time intervals. The review was approved by our IRB.

RESULTS: 376 patients were reviewed. All had a one-month CT. 40 (10%) had an abnormal one-month CT: five had type 1 endoleaks, 34 had type 2 endoleaks, and one had a type 3 endoleak; all were followed with six-month CT. 336 (90%) had a normal one-month CT without endoleaks or other abnormalities. Of these 336 patients, Group I (130 patients) underwent routine six-month CT with only two abnormalities noted (1.5%); both were type 2 endoleaks not associated with sac growth. No six-month CT in this group demonstrated findings warranting intervention. Group II (206 patients) had no six-month CT and were followed only at one year. No patient had one-year findings that would have benefited from a six-month CT. Clinical complications occurred in three Group I patients (2.3%): seroma, limb occlusion, and main body thrombosis. Only one Group II patient (0.5%) experienced a complication within one year, an Ancure limb occlusion at nine months.

CONCLUSIONS: Following EVAR, a six-month CT after a normal one-month CT does not identify any clinically significant findings warranting intervention and can be omitted safely from the follow-up schedule.