Endovascular aneurysm repair: is imaging surveillance robust, and does it influence long-term mortality?

Waduud, M. A. et al. (2015) Endovascular aneurysm repair: is imaging surveillance robust, and does it influence long-term mortality? CardioVascular and Interventional Radiology, 38(1), pp. 33-39. (doi: 10.1007/s00270-014-0890-5)

Abstract

Purpose: Endovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.<p></p> Methods: A retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.<p></p> Results: Data were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0–38.6) and aneurysm-related mortality was 4.5 % (.8–7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2–58.6), 19.1 % (12.6–25.2), and 47.2 % (17.7–66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8–7.4), 4.4 % (2.2–8.9), and 9.5 % (2.5–33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).<p></p> Conclusion: Only half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Moss, Professor Jonathan and Williams, Miss Claire and Sim, Ms Moira
• Authors: Waduud, M. A., Choong, W. L., Ritchie, M., Williams, C., Yadavali, R., Lim, S., Buchanan, F., Bhat, R., Ramanathan, K., Ingram, S., Cormack, L., and Moss, J. G.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Health Economics and Health Technology Assessment; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: CardioVascular and Interventional Radiology
• Publisher: Springer US
• ISSN: 0174-1551
• ISSN (Online): 1432-086X