title: Compliance of postendovascular aortic aneurysm repair imaging surveillance.
abstract: OBJECTIVE
  Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes.
  
  
  METHODS
  Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months. A Kaplan-Meier analysis was used to compare compliance rates in EVAR patients with hostile neck (HN) vs favorable neck (FN) anatomy (according to instructions for use). A multivariate analysis was also done to correlate compliance and comorbidities.
  
  
  RESULTS
  Forty-three percent were compliant (7% had no follow-up imaging) and 57% were NC. The mean follow-up for compliant patients was 25.4 months (0-119 months) vs 31.4 months for NC (0-140 months). The mean number of imaging was 3.5 for compliant vs 2.6 for NC (P < .0001). Sixty-four percent were NC for HN patients vs 50% for FN patients (P = .0007). The rates of compliance at 1, 2, 3, 4, and 5 years for all patients were 78%, 63%, 55%, 45%, and 32%; and 84%, 68%, 61%, 54%, and 40% for FN patients; and 73%, 57%, 48%, 37%, and 25% for HN patients (P = .009). The NC rate for patients with late endoleak and/or sac expansion was 58% vs 54% for patients with no endoleak (P = .51). The NC rate for patients with late reintervention was 70% vs 53% for patients with no reintervention (P = .1254). Univariate and multivariate analyses showed that patients with peripheral arterial disease had an odds ratio of 1.9 (P = .0331), patients with carotid disease had an odds ratio of 2 (P = .0305), and HN patients had an odds ratio of 1.8 (P = .0007) for NC. Age and residential locations were not factors in compliance.
  
  
  CONCLUSIONS
  Overall, compliance of imaging surveillance after EVAR was low, particularly in HN EVAR patients, and additional studies are needed to determine if strict post-EVAR surveillance is necessary, and its effect on long-term clinical outcome.
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa. Electronic address: ali.aburahma@camc.org.
authors.forename: Ali F
authors.initials: AF
authors.lastname: AbuRahma
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa.
authors.forename: Michael
authors.initials: M
authors.lastname: Yacoub
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hass
authors.affiliation: Marshall University, Huntington, WVa.
authors.forename: Joseph
authors.initials: J
authors.lastname: AbuRahma
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa.
authors.forename: Albeir Y
authors.initials: AY
authors.lastname: Mousa
authors.affiliation: CAMC Health Education and Research Institute, Charleston, WVa.
authors.forename: L Scott
authors.initials: LS
authors.lastname: Dean
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa.
authors.forename: Ravi
authors.initials: R
authors.lastname: Viradia
authors.affiliation: Department of Surgery, West Virginia University, Charleston, WVa.
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods / Q000592:standards*; D016009:Chi-Square Distribution; D015897:Comorbidity; D057867:Endoleak / Q000000981:diagnostic imaging / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D010349:Patient Compliance; D011237:Predictive Value of Tests; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000592:standards*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000592:standards*