The durability of EVAR--what are the evidence and implications on follow-up?
OBJECTIVE
To investigate the durability of EVAR and to explore the evidence for follow-up investigations. Furthermore, to study the patients' impressions of followup investigations, and how complications and secondary procedures influence cost-effectiveness.


METHODS
263 patients were treated by EVAR from February 1995-February 2007. The series is divided into two groups with the year 2000 as a cut-off point since a new generation of stent grafts was then introduced. Early and late complications and secondary procedures were recorded. A questionnaire study was performed to investigate the patients' views on the follow-up program.


RESULTS
There was a significant reduction of complications from period I to period II, which was also reflected in the reduction of secondary procedures. Freedom from secondary procedures were 47% and 93% at 5 years follow-up in the two periods, respectively. In phase II, 7.5% of the patients needed a secondary procedure. Limb extension and femoro-femoral bypass were the most common procedures. Since late complications still occur, and can be unpredictable, a follow-up program is necessary. The vast majority of the patients tolerated the follow-up program well.


CONCLUSIONS
Although the number of complications following EVAR has decreased significantly over the years, a thorough follow-up program is still necessary. This followup regime is well tolerated by the patients. Reduction of secondary procedures is important to improve the cost-effectiveness of EVAR.
Department of Surgery, St. Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway.
C
C
Lange
J K
JK
Aasland
A
A
Ødegård
H O
HO
Myhre
D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D015607:Stents / Q000009:adverse effects