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Home > Vascular Annual Meeting > chaer_duplex_ultrasound

Duplex Ultrasound as the Sole Long-Term Surveillance Method Post EVAR: A Safe Alternative for Stable Aneurysms

Rabih A. Chaer, Anya Gushchin, Robert Rhee, Luke Marone, Steven Leers, Michel S. Makaroun.
University of Pittsburgh, Pittsburgh, Pa.

OBJECTIVES: Long-term surveillance with CT after EVAR is a significant drawback of the technique as it increases both cost and risk. The purpose of this study is to evaluate an alternative follow-up modality with color flow duplex ultrasound scanning (CDU) as the sole method of imaging.

METHODS: In 2003, we initiated a new follow-up (FU) schedule with yearly CDU as the sole imaging method for selected patients. Indications included a residual sac of less than 4 cm, expanded later to stable sac size for more than 2 years. A stable type II endoleak was not a contraindication. CT scans were obtained selectively based on suspicious findings of a new endoleak or enlarging sac on CDU. The records of all patients with at least one year FU under this schedule were reviewed

RESULTS: 184 patients were followed with CDU only from 1-4 years for a mean of 24±13 months. The new schedule was initiated 34±24 months after EVAR (range 1-112 months). 23 patients had previous endoleaks that had resolved spontaneously or had been treated. During CDU FU, 3 new endoleaks were detected, 1 with sac enlargement. All prompted CT evaluation: one type II endoleak with stable sac size could not be identified on CT 3 months later, and 2 distal type I endoleaks that required limb extension. All 3 had a prior Ancure endograft. Two patients (1 Ancure, 1 AneuRx) had increased sac size with no endoleak on CDU, confirmed by a normal CT scan and angiogram. No ruptures or graft occlusions were noted. 1 AAA related death followed graft explanation of an Ancure for infection. There were 2 additional deaths from malignancy and 2 from cardiac causes. After the FU switch, freedom from endoleaks was 96%, and from secondary interventions 95% @ 48 months by life table method. Mean AAA diameter at baseline was 54±8 mm and decreased to 40±11 mm before the switch to CDU only FU. At last FU mean aneurysm diameter was 39±11 mm. Graft specific aneurysm characteristics and follow-up are detailed in Table 1. The overall survival rate of this cohort since the original EVAR was 84% at 11 years.

CONCLUSIONS: CDU only surveillance post-EVAR is safe and can be initiated early after treatment in patients with shrinking or stable aneurysms, especially in patients with renal impairment. This policy should result in cost savings advantage and avoid the complications associated with CT.
AUTHOR DISCLOSURES: R.A. Chaer, None; A. Gushchin, None; R. Rhee, WL Gore; L. Marone, None; S. Leers, None; M.S. Makaroun, None.

Table 1.