Vincent Kirkpatrick, Samuel E. Wilson
Surgery, University of California Irvine, Orange, CA.
OBJECTIVES: Standard surveillance after endovascular aneurysm repair (EVAR) consists of contrast-enhanced CT scans, usually at 1 month, 6 months and annually for 5 years. These are expensive and expose patients to nephrotoxic contrast and ionizing radiation. We hypothesized that a normal CTA with no endoleak within 1 month after EVAR predicts a low rate of future complications, which would justify a reduction in subsequent CT scans.
METHODS: We examined the medical records of 104 patients who underwent EVAR at a single hospital, reviewing all postoperative CTAs and noting any complications including endoleak, aneurysm sac growth and any surgical or endovascular intervention. Thirteen patients who had no postoperative contrast-enhanced CT scans were excluded. Our practice has been to obtain CTAs at postoperative months 1, 6 and 12 and then yearly for 5 years.
RESULTS: The mean patient follow-up was 3.4+/-2 years. Of 91 patients, 71 (78%) had a normal CTA at 1 month after EVAR without endoleak or other abnormality. Four of these 71 (5.6%) developed late complications consisting of 3 type II endoleaks and 1 type I endoleak, which presented on postoperative days 240, 1,135, 1,383 and 1,294, respectively. Only 1 of the type II endoleaks was accompanied by aneurysm sac growth requiring repair and the small type I endoleak was also repaired.
CONCLUSIONS: For patients who have a normal CTA with no endoleak one month after EVAR, it is reasonable to consider less frequent CTA surveillance as no significant complications requiring intervention occurred before three years.
AUTHOR DISCLOSURES: V. Kirkpatrick: Nothing to disclose; S. E. Wilson: Nothing to disclose.
Posted April 2013