Abstract
Surveillance after endovascular abdominal aortic aneurysm repair (EVAR) is widely considered mandatory. The purpose of surveillance is to detect asymptomatic complications, so that early secondary intervention can prevent late aneurysm rupture. CT angiography has been taken as the reference standard imaging test, but there is increasing interest in using other modalities to reduce the use of ionising radiation and iodinated contrast. As a result, there is wide heterogeneity in surveillance strategies used among EVAR centres. We reviewed the current evidence available on the outcomes of different imaging modalities and surveillance strategies following EVAR.
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References
Leurs LJ, Buth J, Laheiji RJ, for the EUROSTAR Collaborators (2007) Long-term results of endovascular abdominal aortic aneurysm treatment with the first generation of commercially available stent grafts. Arch Surg 143:33–41
Blakensteijn JD, De Jong SE, Prinssen M, van der Ham AC, Buth J, van Sterkenburg SM, Verhagen JH, Buskens E, Grobbee DE, Dutch Randomized Endovascular Aneurysm Management (DREAM) Trial Group (2005) Two-year outcomes after conventional or endovascular repair of abdominal aortic aneurysms. N Engl J Med 352:2398–2405
EVAR trial participants (2005) Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trial 1): randomised controlled trial. Lancet 365:2179–2186
EVAR trial participants (2005) Endovascular aneurysm repair and outcome in patients unfit for open repair of abdominal aortic aneurysm (EVAR trial 2): randomised controlled trial. Lancet 365:2187–2192
Lederle FA, Freischlag JA, Kyriakides TC, Padberg FT Jr, Matsumura JS, Kohler TR, Lin PH, Jean-Claude JM, Cikrit DF, Swanson KM, Peduzzi PN, Open Versus Endovascular Repair (OVER) Veterans Affairs Cooperative Study Group (2009) Outcomes following endovascular vs. open repair of abdominal aortic aneurysm: a randomized trial. JAMA 302:1535–1542
The United Kingdom EVAR Trial Investigators (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362:1863–1871
De Bruin JL, Baas AF, Buth J, Prinssen M, Verhoeven EL, Cuypers PW, van Sambeek MR, Balm R, Grobbee DE, Blankensteijn JD, DREAM Study Group (2010) Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 362:1881–1889
Lederle FA, Freischlag JA, Kyriakides TC, Matsumura JS, Padberg FT Jr, Kohler TR, Kougias P, Jean-Claude JM, Cikrit DF, Swanson KM, OVER Veterans Affairs Cooperative Study Group (2012) Long-term comparison of endovascular and open repair of abdominal aortic aneurysm. N Engl J Med 367:1988–1997
Karthikesalingam A, Page AA, Pettengell C, Hinchliffe RJ, Loftus IM, Thompson MM, Holt PJ (2011) Heterogeneity in surveillance after endovascular aneurysm repair in the UK. Eur J Vasc Endovasc Surg 42:585–590
Black SA, Carrell TW, Bell RE, Waltham M, Reidy J, Taylor PR (2009) Long-term surveillance with computed tomography after endovascular aneurysm repair may not be justified. Br J Surg 96:1280–1283
Dias NV, Riva L, Ivancev K, Resch T, Sonesson B, Malina M (2009) Is there a benefit of frequent CT follow-up after EVAR? Eur J Vasc Endovasc Surg 37:425–430
Karthikesalingam A, Holt PJ, Hinchliffe RJ, Nordon IM, Loftus IM, Thompson MM (2010) Risk of re-intervention after endovascular aortic aneurysm repair. Br J Surg 97:657–663
Sharma P, Kyriakides C (2007) Surveillance of patients post-endovascular aneurysm repair. Postgrad Med J 83:750–753
Moll FL, Powell JT, Fraedrich G, Verzini F, Jaulon S, Waltham M, van Herwaarden JA, Holt PJ, van Keulen JW, Rantner B, Schlösser FJ, Setacci F, Ricco JB, European Society for Vascular Surgery (2011) Management of abdominal aortic aneurysms clinical practice guidelines of the European Society for Vascular Surgery. Eur J Vasc Endovasc Surg 41(Suppl 1):S1–S58
Patel A, Edwards R, Chandramohan S (2013) Surveillance of patients post-endovascular abdominal aortic aneurysm repair (EVAR). A web-based survey of practice in the UK. Clin Radiol 68:580–587
Uthoff H, Pena C, Katzen BT, Gandhi R, West J, Benenati JF, Geisbusch P (2012) Current clinical practice in postoperative endovascular aneurysm repair imaging surveillance. J Vasc Interv Radiol 23:1152–1159
Iezzi R, Cotroneo AR, Filippone A, Santoro M, Basilico R, Storto ML (2008) Multidetector-row computed tomography angiography in abdominal aortic aneurysm treated with endovascular repair: evaluation of optimal timing of delayed phase imaging for the detection of low-flow endoleaks. J Comput Assist Tomogr 32:609–615
Rozenblit A, Patlas M, Rosenbaum AT, Okhi T, Veith FJ, Laks MP, Ricci ZJ (2003) Detection of endoleaks after endovascular repair of abdominal aortic aneurysm: value of unenhanced and delayed helical CT acquisitions. Radiology 227:426–433
Golzarian J, Dussaussois L, Abada HT, Gevenois PA, Van Gansbeke D, Ferreira J, Struyven J (1998) Helical CT of aorta after endoluminal stent-graft therapy: value of biphasic acquisition. AJR Am J Roentgenol 171:329–331
Motaganahalli R, Martin A, Feliciano B, Murphy MP, Slaven J, Dalsing MC (2012) Estimating the risk of solid organ malignancy in patients undergoing routine computed tomography scans after endovascular aneurysm repair. J Vasc Surg 56:929–937
Sodickson A, Baeyens PF, Andriole KP, Prevedello LM, Nawfel RD, Hanson R, Khorasani R (2009) Recurrent CT, cumulative radiation exposure, and associated radiation-induced cancer risks from CT of adults. Radiology 251:175–184
White HA, Macdonald S (2010) Estimating risk associated with radiation exposure during follow-up after endovascular aortic repair (EVAR). J Cardiovasc Surg (Torino) 51:95–104
Noll RE Jr, Tonnessen BH, Mannava K, Money SR, Sterbergh WC 3rd (2007) Long-term postreplacement costs after endovascular aneurysm repair. J Vasc Surg 46:9–15
Iezzi R, Cotroneo AR, Filippone A, Di Fabio F, Quinto F, Colosimo C, Bonomo L (2006) Multidetector CT in abdominal aortic aneurysm treated with endovascular repair: are unenhanced and delayed phase enhanced images effective for endoleak detection? Radiology 241:915–921
Macari M, Chandarana H, Schmidt B, Lee J, Lamparello P, Babb J (2006) Abdominal aortic aneurysm: can the arterial phase at CT evaluation after endovascular repair be eliminated to reduce radiation dose? Radiology 241:908–914
Bastos RM, Razuk Filho A, Blasbalg R, Caffaro RA, Karakhanian WK, Rocha AJ (2011) A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair. Clinics 66:2025–2029
Hong C, Heiken JP, Sicard GA, Pilgram TK, Bae KT (2008) Clinical significance of endoleak detected on follow-up CT after endovascular repair of abdominal aortic aneurysm. AJR Am J Roentgenol 191:808–813
Bley TA, Chase PJ, Reeder SB, Francois CJ, Shinki K, Tefera G, Ranallo FN, Grist TM, Pozniak M (2009) Endovascular abdominal aortic aneurysm repair: nonenhanced volumetric CT for follow-up. Radiology 253:253–262
Kranokpiraksa P, Kaufman J (2008) Follow-up of endovascular aneurysm repair: plain radiography, ultrasound, CT/CT angiography, MR imaging/MR angiography, or what? J Vasc Interv Radiol 19:S27–S36
Habets J, Zandvoort HJ, Reitsma JB, Bartels LW, Moll FL, Leiner T, van Herwaarden JA (2013) Magnetic resonance imaging is more sensitive than computed tomography angiography for the detection of endoleaks after endovascular abdominal aortic aneurysm repair: a systematic review. Eur J Vasc Endovasc Surg. doi:10.1016/j.ejvs.2012.12.014
Lookstein R, Goldman J, Pukin L, Marin ML (2004) Time-resolved magnetic resonance angiography as a noninvasive method to characterize endoleaks: initial results compared with conventional angiography. J Vasc Surg 39:27–33
Stavropoulos SW, Charagundia SR (2007) Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Radiology 243:641–655
Thomsen HS, Morcos SK, Almen T, Bellin MF, Bertolotto M, Bongartz G, Clement O, Leander P, Heinz-Peer G, Reimer P, Stacul F, van der Molen A, Webb JA, ESUR Contrast Medium Safety Committee (2013) Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 23:307–318
Ayuso JR, de Caralt TM, Pages M, Riambau V, Ayuso C, Sanchez M, Real MI, Montana X (2004) MRA is useful as a follow-up technique after endovascular repair of aortic aneurysm with nitinol endo-prosthesis. J Magn Reson Imaging 20:803–810
van der Laan MJ, Bartels LW, Viergever MA, Blankensteijn JD (2006) Computed tomography versus magnetic resonance imaging of endoleaks after EVAR. Eur J Vasc Endovasc Surg 32:361–365
Cantisani V, Ricci P, Grazhdani H, Napoli A, Fanelli F, Catalano C, Galati G, D’Andrea V, Biancari F, Passariello R (2011) Prospective comparative analysis of colour-doppler ultrasound, contrast-enhanced ultrasound, computed tomography and magnetic resonance in detecting endoleak after endovascular abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 41:186–192
Pitton MB, Schweitzer H, Herber S, Schmiedt W, Neufang A, Kalden P, Thelen M, Duber C (2005) MRI versus helical CT for endoleaks detection after endovascular aneurysm repair. AJR Am J Roentgenol 185:1275–1281
Alerci M, Oberson M, Fogliata A, Gallino A, Vock P, Wyttenbach R (2009) Prospective, intraindividual comparison of MRI versus MDCT for endoleak detection after endovascular repair of abdominal aortic aneurysms. Eur Radiol 19:1223–1231
Wieners G, Meyer F, Halloul Z, Peters N, Ruhl R, Dudeck O, Tautenhahn J, Ricke J, Pech M (2010) Detection of type II endoleak after endovascular aortic repair: comparison between magnetic resonance angiography and blood-pool contrast agent and dual-phase computed tomography angiography. Cardiovasc Intervent Radiol 33:1135–1142
Cornelissen S, Prokop M, Verhagen HJ, Adriaensen ME, Moll FL, Bartels LW (2010) Detection of occult endoleaks after endovascular treatment of abdominal aortic aneurysm using magnetic resonance imaging with a blood pool contrast agent. Invest Radiol 45:548–553
Haulon S, Lions C, McFadden E, Koussa M, Gaxotte V, Halna P, Beregi JP (2001) Prospective evaluation of magnetic resonance imaging after endovascular treatment of infrarenal aortic aneurysms. Eur J Vasc Endovasc Surg 22:62–69
Cejna M, Loewe C, Schoder M, Dirisamer A, Holzenbein T, Kretschmer G, Lammer J, Thurnher S (2002) MR angiography vs CT angiography in the follow-up of nitinol stent grafts in endoluminally treated aortic aneurysms. Eur Radiol 12:2443–2450
Inkso EK, Kulzer LM, Fairman RM, Carpenter JP, Stavropoulos SW (2003) MR imaging for the detection of endoleaks in recipients of abdominal aortic stent-grafts with low magnetic susceptibility. Acad Radiol 10:509–513
Ersoy H, Jacobs P, Kent CK, Prince MR (2004) Blood pool MR angiography of aortic stent-graft endoleak. AJR Am J Roentgenol 182:1181–1186
Millen A, Canavati R, Harrison G, McWilliams RG, Wallace S, Vallabhaneni SR, Fisher RK (2013) Defining a role for contrast-enhanced ultrasound in endovascular aneurysm repair surveillance. J Vasc Surg 58:18–23
Karthikesalingam A, Al-Jundi W, Jackson D, Boyle JR, Beard JD, Holt PJ, Thompson MM (2012) Systematic review and meta-analysis of duplex ultrasonography, contrast-enhanced ultrasonography or computed tomography for surveillance after endovascular aneurysm repair. Br J Surg 99:1514–1523
Gray C, Goodman P, Herron CC, Lawler LP, O’Malley MK, O’Donohoe MK, McDonnell CO (2012) Use of colour duplex ultrasound as a first line surveillance tool following EVAR is associated with a reduction in cost without compromising accuracy. Eur J Vasc Endovasc Surg 44:145–150
Beeman BR, Doctor LM, Doerr K, McAfee-Bennett S, Dougherty MJ, Calligaro KD (2009) Duplex ultrasound imaging alone is sufficient for midterm endovascular aneurysm repair surveillance: a cost analysis study and prospective comparison with computed tomography scan. J Vasc Surg 50:1019–1024
Bakken AM, Illig KA (2010) Long-term follow-up after endovascular aneurysm repair: is ultrasound alone enough? Perspect Vasc Surg Endovasc Ther 22:145–151
Bargellini I, Cioni R, Napoli V, Petruzzi P, Vignali C, Cicorelli A, Sardella S, Ferrari M, Bartolozzi C (2009) Ultrasonographic surveillance with selective CTA after endovascular repair of abdominal aortic aneurysm. J Endovasc Ther 16:93–104
Shah A, Stavropoulos SW (2009) Imaging surveillance following endovascular aneurysm repair. Semin Intervent Radiol 26(1):10–16
Murphy M, Hodgson R, Harris PL, McWilliams RG, Hartley DE, Lawrence-Brown MM (2003) Plain radiographic surveillance of abdominal aortic stent-grafts: the Liverpool/Perth protocol. J Endovasc Ther 10:911–912
Hodgson R, McWilliams R, Simpson A, Gould DA, Brennan JA, Gilling-Smith GL, Harris PL (2003) Migration versus apparent migration: importance of errors due to positioning variation in plain radiographic follow-up of aortic stent-grafts. J Endovasc Ther 10:902–910
Harrison GJ, Oshin OA, Vallabhaneni SR, Brennan JA, Fisher RK, McWilliams RG (2011) Surveillance after EVAR based on duplex ultrasound and abdominal radiography. Eur J Vasc Endovasc Surg 42:187–192
Springer F, Gunther RW, Schmitz-Rode T (2008) Aneurysm sac pressure measurement with minimally invasive implantable pressure sensors: an alternative to current surveillance regimes after EVAR? Cardiovasc Intervent Radiol 31:460–467
Dias NV, Ivancev K, Malina M, Resch T, Lindblad B, Sonesson B (2004) Intra-aneurysm sac pressure measurements after endovascular aneurysm repair: differences between shrinking, unchanged, and expanding aneurysms with and without endoleaks. J Vasc Surg 39:1229–1235
Ohki T, Ouriel K, Silveira PG, Katzen B, White R, Criado F, Diethrich E (2007) Initial results of wireless pressure sensing for endovascular aneurysm repair: the APEX trial: acute pressure measurement to confirm aneurysm sac exclusion. J Vasc Surg 45:236–242
Ellozy SH, Carroccio A, Lookstein RA, Jacobs TS, Addis MD, Teodorescu VJ, Marin ML (2006) Abdominal aortic aneurysm sac shrinkage after endovascular aneurysm repair: correlation with chronic sac pressure measurement. J Vasc Surg 43:2–7
Collins JT, Boros MJ, Combs K (2007) Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography. Ann Vasc Surg 21:671–675
Chaer RA, Gushchin A, Rhee R, Marone L, Cho JS, Leers S, Makaroun MS (2009) Duplex ultrasound as the sole long-term surveillance method post-endovascular aneurysm repair: a safe alternative for stable aneurysms. J Vasc Surg 49:845–850
Schlösser FJV, Gusberg RJ, Dardik A, Lin PH, Verhagen HJ, Moll FL, Muhs BE (2009) Aneurysm rupture after EVAR: can the ultimate failure be predicted? Eur J Vasc Endovasc Surg 37:15–22
Nordon IM, Karthikesalingam A, Hinchliffe RJ, Holt PJ, Loftus IM, Thompson MM (2010) Secondary interventions following endovascular aneurysm repair (EVAR) and the enduring value of graft surveillance. Eur J Vasc Endovasc Surg 39:547–554
Waasdorp E, van Herwaaden JA, van de Mortel RH, Moll FL, de Vries JP (2008) Early computed tomographic angiography after endovascular aneurysm repair: worthwhile or worthless? Vascular 16:253–257
Go MR, Barbato JE, Rhee RY, Makaroun MS (2008) What is the clinical utility of a 6-month computed tomography in the follow-up of endovascular aneurysm repair patients? J Vasc Surg 47:1181–1187
Sternbergh WC 3rd, Greenberg RK, Chuter TA, Tonnessen BH, Zenith Investigators (2008) Redefining postoperative surveillance after endovascular aneurysm repair: recommendations based on 5-year follow-up in the US Zenith multicenter trial. J Vasc Surg 48:278–285
Stokmans RA, Teijink JA, Forbes TL, Böckler D, Peeters PJ, Riambau V, Hayes PD, van Sambeek MR (2012) Early results from the ENGAGE registry: real-world performance of the Endurant stent graft for endovascular AAA repair in 1262 patients. Eur J Vasc Endovasc Surg 44:369–375
Sternbergh WC 3rd, Carter G, York JW, Yoselevitz M, Money SR (2002) Aortic neck angulation predicts adverse outcomes with endovascular abdominal aortic aneurysm repair. J Vasc Surg 35:482–486
Dillavou ED, Muluk SC, Rhee RY, Tzeng E, Woody JD, Gupta N, Makaroun MS (2003) Does hostile neck anatomy preclude successful endovascular aortic aneurysm repair? J Vasc Surg 38:657–663
Hobo R, Kievit J, Leurs LJ, Buth J, EUROSTAR Collaborators (2007) Influence of severe infrarenal aortic neck angulation on complications at the proximal neck following endovascular AAA repair: a Eurostar study. J Endovasc Ther 14:1–11
AbuRahma AF, Campbell J, Stone PA, Nanjundappa A, Jain A, Dean LS, Habib J, Keiffer T, Emmett M (2009) The correlation of aortic neck length to early and late outcomes in endovascular aneurysm repair patients. J Vasc Surg 50:738–748
Antoniou GA, Geogiadis GS, Antoniou SA, Kuhan G, Murray D (2013) A meta-analysis of outcomes of endovascular abdominal aortic aneurysm repair in patients with hostile and friendly neck anatomy. J Vasc Surg 57:527–538
Torsello G, Troisi N, Donas KP, Austermann M (2011) Evaluation of the Endurant stent graft under instructions for use vs off-label conditions for endovascular aortic aneurysm repair. J Vasc Surg 54:300–306
Bastos Goncalves F, van de Luijtgaarden KM, Hoeks SE, Hendriks JM, ten Raa S, Rouwet EV, Stolker RJ, Verhagen HJ (2013) Adequate seal and no endoleak on the first postoperative computed tomography angiography as criteria for no additional imaging up to 5 years after endovascular aneurysm repair. J Vasc Surg 57:1503–1511
Patel MS, Carpenter JP (2010) The value of the initial post-EVAR computed tomography angiography scan in predicting future secondary procedures using the Powerlink stent graft. J Vasc Surg 52:1135–1139
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Donald M.L. Tse, Charles R. Tapping, Rafiuddin Patel, Robert Morgan, Mark J. Bratby, Susan Anthony, Raman Uberoi have no conflict of interest.
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Tse, D.M.L., Tapping, C.R., Patel, R. et al. Surveillance After Endovascular Abdominal Aortic Aneurysm Repair. Cardiovasc Intervent Radiol 37, 875–888 (2014). https://doi.org/10.1007/s00270-014-0916-z
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DOI: https://doi.org/10.1007/s00270-014-0916-z