Endovascular aneurysm repair: is imaging surveillance robust, and does it influence long-term mortality?
OBJECTIVE
Endovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.


METHODS
A retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.


RESULTS
Data were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0-38.6) and aneurysm-related mortality was 4.5 % (.8-7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2-58.6), 19.1 % (12.6-25.2), and 47.2 % (17.7-66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8-7.4), 4.4 % (2.2-8.9), and 9.5 % (2.5-33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).


CONCLUSIONS
Only half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.
Department of Surgery, Glasgow Royal Infirmary, Glasgow, Scotland, United Kingdom, m.a.waduud@doctors.org.uk.
Mohammed Abdul
MA
Waduud
Wen Ling
WL
Choong
Moira
M
Ritchie
Claire
C
Williams
Reddi
R
Yadavali
Shueh
S
Lim
Fraser
F
Buchanan
Raj
R
Bhat
Krishnappan
K
Ramanathan
Susan
S
Ingram
Laura
L
Cormack
Jonathan G
JG
Moss
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome