title: Mortality and Rates of Secondary Intervention After EVAR in an Unselected Population: Influence of Simple Clinical Categories and Implications for Surveillance.
abstract: BACKGROUND
  Post-EVAR surveillance has a major impact upon patients, carers and healthcare resources. We hypothesised that elective indication, on-IFU anatomy, use of a modern device or normal first CTA, or a combination of these categories, might predict a rate of secondary intervention low enough to alter current surveillance protocols.
  
  
  METHODS
  Patients undergoing EVAR in our institution between 01.05.2007 and 28.02.2013 were assessed. Data on indication (elective, emergency), anatomy relative to IFU, device, first month CTA result, secondary intervention and mortality were obtained. Kaplan-Meier charts of mortality and freedom from secondary intervention were produced. Statistical analysis was by log-rank test and Cox proportional hazard modelling.
  
  
  RESULTS
  234 patients underwent EVAR (188 elective, 208 on-IFU). Most implants were Endurant (106) or Talent (98). 151 patients had a normal first CTA. By median follow-up of 38.6 months, 39 patients underwent secondary intervention. A normal first CTA and elective indication were significantly associated with reduced risk of secondary intervention (p < 0.001 and p = 0.042 respectively), but device type and placement on- or off-IFU were not. Elective placement with a normal first CTA was 93 % predictive of freedom from secondary intervention by 32 months post-EVAR. Of nine patients undergoing secondary intervention in this group, eight presented symptomatically.
  
  
  CONCLUSIONS
  In optimal procedural circumstances with normal post-procedural imaging, only 7 % of patients undergoing EVAR require secondary intervention, a minority of which is driven by surveillance. These data support a change to surveillance more tailored to the individual patient, and highlight the need for further qualitative and quantitative research.
authors.affiliation: Department of Vascular Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK. christopherhammond@nhs.net.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Hammond
authors.affiliation: Department of Vascular Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Asim H
authors.initials: AH
authors.lastname: Shah
authors.affiliation: Department of Vascular Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Snoddon
authors.affiliation: Department of Vascular Radiology, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: Jai V
authors.initials: JV
authors.lastname: Patel
authors.affiliation: Department of Vascular Surgery, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Great George Street, Leeds, LS1 3EX, UK.
authors.forename: D Julian A
authors.initials: DJ
authors.lastname: Scott
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000379:methods* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007083:Iliac Artery; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D016016:Proportional Hazards Models; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Abdominal; Aortic aneurysm; Endovascular procedures; Follow-up studies; Surveillance