Intermediate follow-up after endovascular aneurysm repair: can we forgo CT scanning in certain patients?

Area of Science:

• Vascular Surgery
• Medical Imaging
• Health Economics

Background:

• Current guidelines recommend annual computed tomographic (CT) scans for post-endovascular repair of abdominal aortic aneurysms (EVAR) surveillance.
• The necessity of routine CT scans for all patients after EVAR, particularly those with stable anatomy, is questioned.

Purpose of the Study:

• To evaluate the need for continued annual CT scans after EVAR in patients with stable or shrinking aneurysm sacs and no endoleak at one year.
• To determine if alternative surveillance methods are sufficient for this patient subgroup.

Main Methods:

• Retrospective review of 415 patients undergoing EVAR with commercially available grafts and at least 18 months follow-up.
• Analysis of secondary intervention rates based on graft type (Zenith, AneuRx, Excluder) and aneurysm sac behavior at one year.

Main Results:

• Of 93 eligible patients, 71 (76%) had stable/shrinking aneurysm sacs without endoleak at one year.
• Only two patients in this stable group required reintervention, both with AneuRx grafts, and issues were identifiable without CT.
• Secondary intervention rates after year one varied by graft type: Zenith (3%), AneuRx (22%), Excluder (8%).

Conclusions:

• Patients with stable or shrinking aneurysm sacs and no endoleak one year post-EVAR may not require routine annual CT scans.
• Ultrasound and/or clinical evaluation may be sufficient for surveillance in this low-risk group, potentially reducing healthcare costs.
• Further investigation into graft-specific surveillance protocols is warranted.