CardioVascular and Interventional Radiology

, Volume 38, Issue 1, pp 33–39 | Cite as

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

  • Mohammed Abdul Waduud
  • Wen Ling Choong
  • Moira Ritchie
  • Claire Williams
  • Reddi Yadavali
  • Shueh Lim
  • Fraser Buchanan
  • Raj Bhat
  • Krishnappan Ramanathan
  • Susan Ingram
  • Laura Cormack
  • Jonathan G. Moss
Clinical Investigation

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.

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.

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).

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.

Keywords

AAA EVAR Mortality Surveillance 

Notes

Acknowledgments

Funded by an Endowment fund from the Glasgow and Clyde hospitals, Scotland. No support was provided by pharmaceutical or medical-device companies. The authors acknowledge the support provided by Andrew Tambyraja, vascular surgeon, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom, for facilitating assess to relevant databases at their local vascular unit. Statistical analysis was performed by C.W.

Conflict of interest

C.W. received financial support from an Endowment fund from the Greater Glasgow and Clyde hospitals, Scotland, during the conduct of the study. The other authors declare that they have no conflict of interest.

References

  1. 1.
    National Institute for Health and Clinical Excellence (2009) Endovascular stent-grafts for the treatment of abdominal aortic aneurysms. National Institute for Health and Clinical Excellence (NICE), London. http://www.guideline.gov/content.aspx?id=14447
  2. 2.
    Chaikof EL, Brewster DC, Dalman RL et al (2009) The care of patients with an abdominal aortic aneurysm: the Society for Vascular Surgery practice guidelines. J Vasc Surg 50(4 suppl):S2–S49PubMedCrossRefGoogle Scholar
  3. 3.
    Greenhalgh RM (2005) Endovascular aneurysm repair versus open repair in patients with abdominal aortic aneurysm (EVAR trail 1): randomised controlled trial. Lancet 365:2179–2186CrossRefGoogle Scholar
  4. 4.
    Prinssen M, Verhoeven ELG, Buth J et al (2004) A randomised trial comparing conventional and endovascular repair of abdominal aortic aneurysms. N Engl J Med 351:1607–1618PubMedCrossRefGoogle Scholar
  5. 5.
    Greenhalgh RM, Brown LC, Powell JT et al (2010) Endovascular versus open repair of abdominal aortic aneurysm. N Engl J Med 362:1863–1871PubMedCrossRefGoogle Scholar
  6. 6.
    Bruin JLD, Baas AF, Buth J et al (2010) Long-term outcome of open or endovascular repair of abdominal aortic aneurysm. N Engl J Med 362:1881–1889PubMedCrossRefGoogle Scholar
  7. 7.
    Vallabhaneni SR, Harris PL (2001) Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm. Eur J Radiol 39:34–41PubMedCrossRefGoogle Scholar
  8. 8.
    Thomas SM, Beard JD, Ireland M, Ayers S, Vascular Society of Great Britain and Ireland and the British Society of Interventional Radiology (2005) Results from the Prospective Registry of Endovascular Treatment of Abdominal Aortic Aneurysms (RETA): mid-term results to five years. Eur J Vasc Endovasc Surg 29:563–570PubMedCrossRefGoogle Scholar
  9. 9.
    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 68:580–587PubMedCrossRefGoogle Scholar
  10. 10.
    Kim HT (2007) Cumulative incidence in competing risks data and competing risks regression analysis. Clin Cancer Res 13:559–565PubMedCrossRefGoogle Scholar
  11. 11.
    Kret MR, Azarbal AF, Mitchell EL et al (2013) Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection. J Vasc Surg 58:25–31PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2014

Authors and Affiliations

  • Mohammed Abdul Waduud
    • 1
  • Wen Ling Choong
    • 7
  • Moira Ritchie
    • 2
  • Claire Williams
    • 2
  • Reddi Yadavali
    • 3
  • Shueh Lim
    • 4
  • Fraser Buchanan
    • 5
  • Raj Bhat
    • 6
  • Krishnappan Ramanathan
    • 8
  • Susan Ingram
    • 4
  • Laura Cormack
    • 4
  • Jonathan G. Moss
    • 9
  1. 1.Department of SurgeryGlasgow Royal InfirmaryGlasgowUnited Kingdom
  2. 2.Institute of Health and Wellbeing GlasgowUniversity of GlasgowScotlandUnited Kingdom
  3. 3.Department of RadiologyAberdeen Royal Infirmary, NHS GrampianAberdeenUnited Kingdom
  4. 4.Department of RadiologyRoyal Infirmary of Edinburgh, NHS LothianEdinburghUnited Kingdom
  5. 5.The School of Medicine and DentistryUniversity of AberdeenAberdeenUnited Kingdom
  6. 6.Department of RadiologyNinewells Hospital, NHS TaysideDundeeUnited Kingdom
  7. 7.Department of SurgeryAberdeen Royal Infirmary, NHS GrampianAberdeenUnited Kingdom
  8. 8.School of MedicineUniversity of DundeeDundeeUnited Kingdom
  9. 9.Department of RadiologyGartnavel General HospitalGlasgowUnited Kingdom

Personalised recommendations