title: The fate of endovascular aortic aneurysm repair after 5 years monitored with duplex ultrasound imaging.
abstract: Interventions for aortic aneurysm sac growth have been reported across multiple time points after endovascular aortic aneurysm repair (EVAR). We report the long-term outcomes of patients after EVAR monitored with duplex ultrasound (DUS) imaging with respect to the need for and type of intervention after 5 years.
  
  
  
  We report a series of patients who were monitored with DUS imaging for a minimum of 5 years after EVAR. DUS imaging was performed in an accredited noninvasive vascular laboratory, and computed tomography angiography was only performed for abnormal DUS findings.
  
  
  
  There were 156 patients who underwent EVAR with follow-up >5 years (mean, 7.5 years; range, 5.1-14.5 years). Interventions for endoleak, graft limb stenosis, or thrombosis were performed in 44 patients (28%) at some time during follow-up. Of the 156 patients, 34 (22%) underwent their first intervention during the first 5 years (25 endoleaks, 9 limb stenoses, or occlusions). Four ruptures occurred, all in patients with their first intervention before 5 years. The remaining 10 patients (6%) underwent a first intervention >5 years after implantation: 3 for type I endoleak, 2 for type II endoleak with sac expansion, 2 for combined type I and II endoleaks 2 for type III endoleak, and 1 unknown type.
  
  
  
  Long-term follow-up of EVAR (mean, 7.5 years) revealed that approximately one in four patients will require intervention at some point during follow-up. First-time interventions were necessary in 22% of all patients in the first 5 years and in 6% of patients after 5 years, highlighting the need for continued graft surveillance beyond 5 years. All patients who had a first-time intervention after 5 years underwent an endoleak repair; none of these patients had a thrombosed limb or a rupture as a result of the endoleak.
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Pineda
authors.affiliation: Section of Vascular Surgery, Danbury Hospital, Danbury, Conn.
authors.forename: Zachary M
authors.initials: ZM
authors.lastname: Phillips
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa. Electronic address: kcalligaro@aol.com.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Calligaro
authors.affiliation: Section of Vascular Surgery, Danbury Hospital, Danbury, Conn.
authors.forename: Emilia
authors.initials: E
authors.lastname: Krol
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Dougherty
authors.affiliation: Section of Vascular Surgery, Pennsylvania Hospital, Philadelphia, Pa.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Troutman
authors.affiliation: Section of Vascular Surgery, Danbury Hospital, Danbury, Conn.
authors.forename: Alan
authors.initials: A
authors.lastname: Dietzek
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D000072226:Computed Tomography Angiography; D003237:Connecticut; D057867:Endoleak / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015143:Philadelphia; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex