Analysis Shows Low Rate of Compliance With Post-EVAR Surveillance

March 2, 2016—In the Journal of Vascular Surgery (JVS), Ali F. AbuRahma, MD, et al published findings from a study that analyzed compliance with imaging surveillance after endovascular aortic aneurysm repair (EVAR) and its effect on clinical outcomes (2016;63:589–595). The investigators concluded that overall compliance of imaging surveillance after EVAR was low, particularly in EVAR patients with hostile neck anatomy. They advised that additional studies are needed to determine if strict post-EVAR surveillance is necessary, as well as to determine its effect on long-term clinical outcomes.

The published study represents a retrospective analysis of prospectively collected data from 565 EVAR patients who were treated August 2001 to November 2013 and followed using duplex ultrasound and/or computed tomography angiography. Patients were considered noncompliant (NC) if they did not have any follow-up imaging for 2 years and/or missed their first post-EVAR imaging over 6 months. Kaplan-Meier analysis was used to compare compliance rates in EVAR patients with hostile neck (HN) versus favorable neck (FN) anatomy, according to instructions for use. Multivariate analysis was also done to correlate compliance and comorbidities.

As summarized in JVS, 43% of patients were compliant and 57% were NC. The mean follow-up for compliant patients was 25.4 months versus 31.4 months for NC. The mean number of imaging was 3.5 for compliant versus 2.6 for NC (P < .0001). It was also determined that noncompliance was 64% for HN patients versus 50% for FN patients. The analysis further detailed rates of compliance annually through 5 years across all patient groups, as well as specifically for FN and HN patiesnts. NC rates were further explored in subgroups of patients with late endoleak and/or sac expansion, as well as reintervention. Univariate and multivariate analyses were performed to determine odds ratios for NC in patients with peripheral artery disease, carotid disease, and HN. 

Demographic factors such as age and residential locations were not determined to be factors in compliance, reported the investigators in JVS.