ENDOVASCULAR ANEURISM REPAIR (EVAR) — CONSIDERATIONS ON CURRENT FOLLOW-UP STRATEGIES

  • Joel Fernando Ferreira Sousa Department of Biomedicine – Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal; Center of Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal
  • João Rocha-Neves Department of Angiology and Vascular Surgery, Centro Hospitalar de São João, Porto, Portugal; Department of Surgery, Faculty of Medicine, University of Porto, Portugal
  • Juliana Macedo Faculty of Medicine, University of Porto, Portugal
  • João Paulo-Castro Department of Biomedicine – Unit of Anatomy, Faculty of Medicine, University of Porto, Portugal; Physical Medicine and Rehabilitation Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
  • José Oliveira-Pinto Center of Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Portugal; Department of Angiology and Vascular Surgery, Centro Hospitalar de São João, Porto, Portugal
  • José Teixeira Department of Angiology and Vascular Surgery, Centro Hospitalar de São João, Porto, Portugal
  • Armando Mansilha Department of Angiology and Vascular Surgery, Centro Hospitalar de São João, Porto, Portugal; Department of Surgery, Faculty of Medicine, University of Porto, Portugal
Keywords: EVAR, Follow-up, CTA, Ultrasound, Radiation

Abstract

Abdominal aortic aneurysm (AAA) is a cumbersome pathology, with catastrophic consequences when not properly diagnosed and treated. Nowadays, EVAR became an established treatment option for AAA, with better perioperative outcomes when compared to open surgery, and is quickly gaining a position of preference among the patients. However, the occurrence of endoleaks is described as the most common adverse event associated to EVAR. Consequently, we review the definition and classification of endoleaks as well as their potential risks and management. Nonetheless, according to the current follow-up protocols of ESVS, this technique requires an extensive imaging follow-up, usually by means of computed tomographic angiography (CTA), which carries increased economic cost and leads us to discuss related great radiation hazards. Concerning the latter, we also review the selected studies and we concluded that the first month CTA is the single most important imaging exam for patients’ prognosis and, once no complications are found, other reviewed imaging follow-up strategies should be undertaken to minimize radiation exposure and yet further risks for the patients. Therefore, this article establishes an overview about the current evidence and future strategies on EVAR imaging follow-up.

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Published
2019-09-04
Section
Review Article