Postoperative CT Evaluation After EVAR: A Comparison of Image Assessment

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Imaging Analysis

Background:

• Postoperative surveillance after endovascular aneurysm repair (EVAR) is crucial for detecting complications.
• Computed tomography angiography (CTA) is a standard imaging modality for EVAR follow-up.
• Assessing the accuracy of different review facilities is important for optimizing patient care.

Purpose of the Study:

• To compare the accuracy of postoperative CTA assessments between a tertiary vascular clinic and an outside core review facility following EVAR.
• To evaluate the detection rates of vascular and extravascular findings by each facility.
• To determine the clinical significance of identified findings and their impact on reintervention rates.

Main Methods:

• Retrospective analysis of 100 patients who underwent routine CTA after EVAR.
• Independent review of CTA scans by vascular surgeons/radiologists at the vascular clinic and an external core review facility.
• Classification of findings as vascular or extravascular and assessment of clinical significance by an independent reviewer.

Main Results:

• The vascular clinic identified more clinically significant vascular findings (stent compression, kinks, endoleaks) compared to the core clinic.
• The core clinic reported more pseudoaneurysms and a higher number of clinically significant extravascular findings, including suspected malignancies.
• Good interrater agreement was observed for overall endoleak detection, with moderate agreement for aneurysm growth assessment.

Conclusions:

• A dedicated vascular clinic effectively identifies most significant vascular findings during routine EVAR surveillance.
• Some clinically significant extravascular findings may be missed by the primary vascular clinic.
• The overall frequency of clinically significant findings or those necessitating reintervention after EVAR was low in this study.