title: Postoperative CT Evaluation After EVAR: A Comparison of Image Assessment.
abstract: OBJECTIVE
  To compare the postoperative computed tomography angiography (CTA) assessment made by vascular surgeons and interventional radiologists after endovascular aneurysm repair (EVAR) at a tertiary vascular clinic to an outside core review facility.
  
  
  METHODS
  One hundred patients (mean age 78.7 years, range 88-55; 84 men) with consecutive, elective, routine CTA controls after EVAR were retrospectively studied. Consultant vascular surgeons or radiologists had evaluated all original scans and written the original report. All scans were then reevaluated by an independent core clinic. Findings were classified as vascular or extravascular and stratified as clinically significant or clinically nonsignificant by an independent external reviewer.
  
  
  RESULTS
  The number of vascular findings detected by the vascular clinic was 72 vs 69 by the core clinic. The vascular clinic reported more clinically significant findings (primarily stent compression or kinks) as well as endoleaks and their origin. The core clinic reported more pseudoaneurysms (24 vs 12). None of the patients with puncture complications needed reintervention. Interrater analysis of all findings between the 2 clinics showed good agreement when comparing endoleaks overall (without subclassification) and moderate agreement when assessing aneurysm growth. The core clinic reported extravascular findings in 58 patients; 37 of these were classified as clinically significant. The vascular clinic reported extravascular findings in 23 patients; 7 of these were clinically significant. The core clinic also reported 2 cases of suspected malignancies, which had not been reported by the vascular clinic.
  
  
  CONCLUSIONS
  During routine CTA follow-up after EVAR, a significant number of vascular and nonvascular findings are detected. Whereas a highly dedicated vascular clinic identifies most vascular findings regardless of the specialty of the reader, some extravascular findings are missed. However, the frequency of clinically significant findings or findings that might warrant reintervention was low in this study.
authors.affiliation: Vascular Center Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Sweden tornqvist.pelle@gmail.com.
authors.forename: Per
authors.initials: P
authors.lastname: Törnqvist
authors.affiliation: Vascular Center Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Sweden.
authors.forename: Timothy
authors.initials: T
authors.lastname: Resch
authors.affiliation: Vascular Center Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Gottsäter
authors.affiliation: Vascular Center Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Malina
authors.affiliation: Vascular Center Department of Hematology and Vascular Diseases, Skåne University Hospital Malmö, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Wasselius
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D003951:Diagnostic Errors; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: aneurysm growth; computed tomography angiography; core laboratory; endoleak; endovascular aneurysm repair; extravascular findings; pseudoaneurysm; puncture complications; radiologist; stent compression; surgeon; target vessel