Factors Affecting Post-EVAR Imaging Surveillance: An Opportunity for Improvement

Area of Science:

• Vascular Surgery
• Medical Imaging
• Health Services Research

Background:

• Society of Vascular Surgery (SVS) guidelines recommend imaging surveillance after endovascular aorta repair (EVAR) for patient monitoring.
• Adherence to these follow-up protocols is crucial for detecting complications like endoleaks.
• This study investigates adherence trends and their impact on endoleak detection post-EVAR.

Purpose of the Study:

• To evaluate the adherence to SVS imaging surveillance guidelines after EVAR.
• To determine the relationship between adherence, time post-EVAR, and endoleak detection.
• To identify factors associated with nonadherence to follow-up imaging.

Main Methods:

• Retrospective cohort study of 395 patients undergoing EVAR from 2014-2022.
• Patients stratified by adherence to SVS imaging recommendations up to five years postoperatively.
• Multivariable logistic regression analyzed factors including distance from facility and Area Deprivation Index (ADI).

Main Results:

• Only 44% of patients adhered to all imaging recommendations, with an average annual loss to follow-up of 9.7%.
• Type II endoleaks were detected in 15.4% of patients during the study period.
• Residence > 50 miles from the institution was an independent risk factor for nonadherence (OR 1.76, p=0.018).

Conclusions:

• Adherence to EVAR surveillance guidelines diminishes over time, yet endoleaks can still be detected years later.
• While distance impacts adherence, patient's Area Deprivation Index did not show a significant association.
• Healthcare providers can play a role in reminding patients and facilitating follow-up imaging appointments to improve adherence.