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Next generation post EVAR follow-up regime.

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Surveillance after endovascular aneurysm repair lacks consensus. New devices and imaging like ultrasound may improve early detection of complications, but risk stratification needs validation.

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Area of Science:

  • Vascular Surgery
  • Medical Imaging
  • Health Services Research

Background:

  • Endovascular aneurysm repair (EVAR) durability is crucial due to potential complications and re-interventions.
  • Current EVAR surveillance protocols are resource-intensive, inefficient, and may not suit all patients.
  • Existing guidelines do not incorporate novel imaging techniques or newer endovascular devices.

Purpose of the Study:

  • To review current international society recommendations for EVAR surveillance.
  • To evaluate emerging imaging modalities as alternatives for EVAR follow-up.
  • To discuss surveillance strategies for novel endovascular devices and risk stratification.

Main Methods:

  • Systematic review of current EVAR surveillance guidelines from international societies.
  • Analysis of evidence for advanced imaging techniques: contrast-enhanced ultrasound (CEUS), 3D-CEUS, and digital tomosynthesis.
  • Review of studies on surveillance for new devices, particularly those with sealing technology.
  • Examination of evidence for risk stratification based on patient anatomy and postoperative imaging.

Main Results:

  • No international consensus exists on optimal EVAR surveillance modality or timing.
  • Novel imaging modalities show promise but require further validation.
  • Surveillance for new sealing devices needs to be more intensive due to undetermined long-term outcomes.
  • Risk stratification of EVAR follow-up is feasible but requires prospective validation.

Conclusions:

  • Current EVAR surveillance strategies are suboptimal and require revision.
  • Advanced imaging and risk stratification hold potential for more efficient and personalized follow-up.
  • Further research is essential to establish standardized, evidence-based surveillance protocols for all EVAR patients.