• Vascular Annual Meeting
• Future Meeting Dates
• Past Meeting Information
• Contact Us

PVSS12. Ultrasound Surveillance After Endovascular Aneurysm Repair (EVAR): Are CT Scans Still Necessary?

Gregory C. Schmieder, Albert I. Richardson, Eric C. Scott, Andre Biuckians, John Snelling, Gordon K. Stokes, Jean M. Panneton.
Vascular & Transplant Specialists, Norfolk, Va.; Eastern Virginia Medical School and Vascular & Transplant Specialists; Norfolk, Va.

OBJECTIVES: Contrast CT scan surveillance after EVAR carries inherent, cumulative risks of radiation and contrast nephrotoxicity. Ultrasound provides another modality to follow EVARs without those risks. To better understand the role that ultrasound plays in EVAR surveillance, we reviewed our 10-year experience.

METHODS: A retrospective review of all patients who underwent endovascular repair for AAA at our institution was performed. Patient history, demographics, procedural details, clinical follow-up, and ultrasound data were collected and analyzed.

RESULTS: From 1996 through July, 2007, 540 consecutive patients underwent an EVAR procedure. Ultrasound surveillance data could only be obtained in 319 patients. During this time, patients underwent a mean of 3.8±3.2 ultrasound studies. Fifty patients (16%) required 81 reinterventions. Reinterventions were performed for limb dysfunction (n=30), endoleaks (n=46), and conversion (n=4). Six patients underwent seven reinterventions based only on symptoms such as acute ischemia. A combination of symptoms and a positive, diagnostic study were used as indications for 21 interventions in 16 patients. Ultrasound correctly predicted 18/18(100%) of these re-interventions; three interventions were based on CT scan only and no ultrasound was performed. 53 re-interventions in 40 patients were based solely on diagnostic findings. Ultrasound predicted 51/52 re-interventions (98%); two patients did not undergo ultrasound evaluation and there was one false positive. Overall, using symptoms and ultrasound evaluation resulted in predicting 99% of re-interventions performed after EVAR.

CONCLUSIONS: Ultrasound and clinical evaluation after EVAR is an excellent predictor of reinterventions after EVAR without the cumulative risks of CT scans.