Frederico M. Bastos Gonçalves, Sander ten Raa, Ellen V. Rouwet, Johanna M. Hendriks, Adriaan Moelker, Hence J. M. Verhagen
Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
OBJECTIVES: To identify patients in which image follow-up was unnecessary for the first 5 years after endovascular aneurysm repair (EVAR).
METHODS: All patients undergoing EVAR using the Excluder endograft at a university institution from 2000 to 2007 were included. Preoperative anatomical characteristics and intraoperative details were registered, and all postoperative computed tomography angiography (CTA) were analyzed. Patients were included in the “optimal group” if fulfilling the following criteria: optimal anatomy (defined according to instructions for use), uneventful operation (deployment at the optimal position, without type-I/III endoleaks) and negative postoperative CTA (absence of type-I/III endoleaks and seal length >10 mm). The remaining patients were considered the “sub-optimal group." Adverse events not predicted or treated preventively as a result of a CTA finding were not considered
RESULTS: One-hundred and forty-four patients were included (mean age 72, 88% male). ASA classification was III/IV in 61.8% and 4.9% were ruptured aneurysms. No patients were lost during follow-up up to 11 years (median 5.0 years). Using Kaplan-Meier analysis, the estimated event-free survival at 5 years was 100% for the “optimal group” (n=42, 29.2%), and 78% for the “sub-optimal” group (p=0.004)
CONCLUSIONS: We suggest that selected patients with optimal anatomy, uneventful operations and a negative first CTA may require no imaging up to five years, since no benefit resulted from that strategy. This would simplify their follow-up considerably, making it comparable to that of open surgery
AUTHOR DISCLOSURES: F. M. Bastos Gonçalves, Nothing to disclose; J. M. Hendriks, Nothing to disclose; A. Moelker, Nothing to disclose; E. V. Rouwet, Nothing to disclose; S. ten Raa, Nothing to disclose; H. M. Verhagen, Nothing to disclose.
Kaplan-Meier analysis for adverse events after EVAR
Posted April 2012