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Title: Endovascular Aneurysm Repair: Is Imaging Surveillance Robust, and Does It Influence Long-term Mortality?

PurposeEndovascular 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.MethodsA 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.ResultsData 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-causemore » 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).ConclusionOnly 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.« less
Authors:
 [1] ;  [2] ; ;  [3] ;  [4] ;  [5] ;  [6] ;  [7] ;  [8] ; ;  [5] ;  [9]
  1. Glasgow Royal Infirmary, Department of Surgery (United Kingdom)
  2. Aberdeen Royal Infirmary, NHS Grampian, Department of Surgery (United Kingdom)
  3. University of Glasgow, Institute of Health and Wellbeing Glasgow (United Kingdom)
  4. Aberdeen Royal Infirmary, NHS Grampian, Department of Radiology (United Kingdom)
  5. Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom)
  6. University of Aberdeen, The School of Medicine and Dentistry (United Kingdom)
  7. Ninewells Hospital, NHS Tayside, Department of Radiology (United Kingdom)
  8. University of Dundee, School of Medicine (United Kingdom)
  9. Gartnavel General Hospital, Department of Radiology (United Kingdom)
Publication Date:
OSTI Identifier:
22470107
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 38; Journal Issue: 1; Conference: IROS 2015: Interventional Radiological Olbert Symposium, Berlin (Germany), 15-17 Jan 2015; Other Information: Copyright (c) 2015 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOMEDICAL RADIOGRAPHY; DEATH; INSPECTION; MEDICAL SURVEILLANCE; MORTALITY; PATIENTS; RADIATION MONITORING; RADIATION PROTECTION; SECURITY; SERVICE LIFE; UNITED KINGDOM; WEAR RESISTANCE