The increasing role of duplex scanning in the follow-up after endovascular repair of abdominal aortic aneurysms
Raffaele Pulli, Walter Dorigo, Leonidas Azas, Stefano Matticari, Aaron Fargion, Carlo Pratesi
Department of Vascular Surgery, University of Florence, Florence, Italy
Aim: To analyze the results of a follow-up program after endovascular repair of abdominal aortic aneurysm (EVAR) mainly based on duplex ultrasound (DUS) examinations.
Materials and methods: The postoperative surveillance program changed over the time. In recent years (2007-2012) we are used to performing a DUS and an angio-CT scan within one month after EVAR, a DUS at 6 and 12 months and every 6 months thereafter (Group 2, 498 interventions). Data were compared with our historical series (2000-2006; Group 1, 345 interventions.) Perioperative results were recorded. The long-term results were analysed by Kaplan-Meier curves.
Results: The rates of perioperative mortality were 1.1% and 1.2% respectively (P=0.9). The cumulative rates of perioperative complications were 16% and 6.5%, respectively (P=0.001). The rate of reinterventions at 60 months was significantly higher in group 2 than in group 1 (29.1% and 20.1% respectively, P=0.03, log rank 4.6). Also the 5-year rate of endoleak was significantly greater in group 2 than group 1 (43.3% and 34.5% respectively, P<0.001, log rank 13.4); however, the rate of endoleaks requiring a redo procedure was lower in group 2 (35/163, 21.5%) than in group 1 (51/108, 47%; P<0.001).
Conclusion: Data from our study confirm that a DUS-based follow-up program in patients undergoing EVAR is equally sensitive in identifying endoleaks to the CT scan-based program used in past years.
Keywords: duplex ultrasound, contrast-enhanced, endovascular aneurysm repair
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