A systematic review of surveillance after endovascular aortic repair

J Vasc Surg. 2018 Jan;67(1):320-331.e37. doi: 10.1016/j.jvs.2017.04.058. Epub 2017 Jun 26.

Abstract

Objective: The objective of this systematic review and meta-analysis was to evaluate the optimal modality and frequency of surveillance after endovascular aortic repair (EVAR) in adult patients with abdominal aortic aneurysms.

Methods: We searched for studies of post-EVAR surveillance in MEDLINE In-Process & Other Non-Indexed Citations, MEDLINE, Embase, Cochrane Database of Systematic Reviews, and Scopus through May 10, 2016. The outcomes of interest were endoleaks, mortality, limb ischemia, renal complications, late rupture, and aneurysm-related mortality. Outcomes were pooled using a random-effects model and were reported as incidence rate and 95% confidence interval.

Results: Of 1099 candidate references, we included 6 meta-analyses and 52 observational studies. Complication rates were common after EVAR, particularly in the first year. Magnetic resonance imaging had a higher detection rate of endoleaks than computed tomography angiography. Doppler ultrasound had lower diagnostic accuracy, whereas contrast-enhanced ultrasound was likely to be as sensitive as computed tomography angiography. The highest endoleak detection rates were in surveillance approaches that used combined tests. There were no studies that compared different surveillance intervals to determine optimal intervals; however, most studies reported detection rates of patient-important outcomes at 1, 6, 12, 24, 36, 48, and 60 months. Data were insufficient to provide comparative inferences about the best strategy to reduce the risk of patient-important outcomes, such as mortality, limb ischemia, rupture, and renal complications.

Conclusions: Several tests with reasonable diagnostic accuracy are available for surveillance after EVAR. The available evidence suggests a high complication rate, particularly in the first year, and provides a rationale for surveillance.

Publication types

  • Evaluation Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Aorta, Abdominal / diagnostic imaging
  • Aorta, Abdominal / surgery
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Rupture / diagnostic imaging
  • Aortic Rupture / epidemiology
  • Aortic Rupture / etiology
  • Blood Vessel Prosthesis Implantation / adverse effects*
  • Blood Vessel Prosthesis Implantation / methods
  • Computed Tomography Angiography / methods
  • Contrast Media / administration & dosage
  • Endovascular Procedures / adverse effects*
  • Endovascular Procedures / methods
  • Extremities / blood supply*
  • Extremities / diagnostic imaging
  • Humans
  • Incidence
  • Ischemia / diagnostic imaging*
  • Ischemia / epidemiology
  • Ischemia / etiology
  • Kidney Diseases / diagnostic imaging
  • Kidney Diseases / epidemiology
  • Kidney Diseases / etiology
  • Magnetic Resonance Angiography / methods
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology
  • Risk Factors
  • Sensitivity and Specificity
  • Time Factors
  • Treatment Outcome
  • Ultrasonography, Doppler, Duplex / methods

Substances

  • Contrast Media