Introduction: Endovascular aneurysm repair (EVAR) is associated with risk of late complications, and requires follow-up. The frequency of follow-up and the optimal imaging modality(ies) for detection of post-EVAR complications is, however, a matter of debate. This study assesses post-EVAR complications and reinterventions in a two-center cohort. The study hypothesis was that a majority of post-EVAR complications are either symptomatic, or can be detected with ultrasound surveillance alone.
Methods: All EVAR patients from 1998-2012 in two centers were included (follow-up routine: post-EVAR imaging at 1, 6, 12 months, and annually thereafter). Preoperative clinical and anatomical parameters, operative data and long-term outcome were assessed. Post-EVAR complications were classified based on if they were symptomatic or imaging detected. For patients who had undergone ultrasound (DUS) and computed tomographic angiography (CTA) imaging within three months from each other, kappa coefficient of agreement was assessed.
Results: Some 454 patients treated with EVAR were identified, with a mean follow-up of 4.9 (range 0-18) years, 118 patients (26%) developed 176 complications, 42 had more than one complication. There was no difference in preoperative parameters between patients with or without complications. One-hundred-and-six (60.2%) of the complications were asymptomatic imaging detected, and 70 (39.8%) were symptomatic; 39.2 % occurred during the first year post-EVAR, 25.6 % during years 2-3, and 19.9 % during years 4-5. Forty-four percent of asymptomatic complications were primarily detected with DUS. Two-hundred-fifty three patients had imaging with the both modalities within 3 months from each other; the kappa coefficient for agreement between CTA and ultrasound for detecting clinically significant complications was 0.91. Ultrasound failed to detect three type I endoleaks, all three had short sealing in the first postoperative CTA.
Conclusion: Approximately one fourth of the patients developed post-EVAR complications, the majority of which were asymptomatic and imaging detected, underlining the importance of adequate surveillance. There was a good agreement between CTA and ultrasound in detecting complications, with a high negative predictive value for ultrasound, indicating that follow-up with the DUS, as the primary surveillance strategy after EVAR is safe in patients with adequate sealing measured on the first postoperative CTA.
Article info
Publication history
P-130 Abdominal Aortic Diseases
Identification
Copyright
© 2019 Published by Elsevier Inc.
User license
Elsevier user license | How you can reuse
Elsevier's open access license policy

Elsevier user license
Permitted
For non-commercial purposes:
- Read, print & download
- Text & data mine
- Translate the article
Not Permitted
- Reuse portions or extracts from the article in other works
- Redistribute or republish the final article
- Sell or re-use for commercial purposes
Elsevier's open access license policy
ScienceDirect
Access this article on ScienceDirectRelated Articles
Comments
Commenting Guidelines
To submit a comment for a journal article, please use the space above and note the following:
- We will review submitted comments as soon as possible, striving for within two business days.
- This forum is intended for constructive dialogue. Comments that are commercial or promotional in nature, pertain to specific medical cases, are not relevant to the article for which they have been submitted, or are otherwise inappropriate will not be posted.
- We require that commenters identify themselves with names and affiliations.
- Comments must be in compliance with our Terms & Conditions.
- Comments are not peer-reviewed.