Postoperative imaging follow-up at two years as a predictor of long-term outcome after endovascular aneurysm repair (EVAR).

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Lifelong imaging follow-up remains the gold standard after endovascular aneurysm repair (EVAR). As the number of EVARs is growing, an individually optimized follow-up protocol is desirable. The aim of this study was to investigate the possibility of creating such a protocol by evaluating patients’ follow-up images and comparing the findings with their freedom from re-interventions and AAA-ruptures.Between 2000 and 2010, 282 patients with an abdominal aortic aneurysm (AAA) underwent elective EVAR with the Zenith stent graft. The patients were followed annually until the end of 2019. The patients were categorized into two groups according to the presence of any endoleak or sac shrinkage at two years – Group A: no detectable endoleak, combined with aneurysm sac shrinkage by ≥ 5 mm (n=137, 63%), and Group B: any type of endoleak or no significant aneurysm sac shrinkage (< 5 mm) (n=82, 37%).The mean follow-up was 83 months (range, 0 – 229 months) and the overall survival at two years 84% (n=237). There was no significant difference in overall survival between groups A and B (p=0.73), but there was significant difference in freedom from AAA- rupture at twelve years favouring group A (100% and 91%, p=0.002). Furthermore, in group A, the freedom from re-interventions was 95% at twelve years, while the figure was only 31% (p< 0.001) in group B. The sensitivity of categorization was 89% and the specificity 74% for finding a re-intervention-requiring complication during the long-term follow-up.Patients with no endoleaks and a reduction of ≥ 5 mm in aneurysm size at two years have significantly fewer late re-interventions and ruptures during long-term follow-up than their counterparts when using COOK Zenith stent graft. This finding suggests that, for these patients, the follow-up interval can be personalized and safely extended after two years.

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Authors: Suvi Väärämäki, Ilkka Uurto, Velipekka Suominen