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Early Follow-Up After Endovascular Aneurysm Repair: Is the First Postoperative Computed Tomographic Angiography Scan Necessary?
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Early Follow-Up After Endovascular Aneurysm Repair: Is the First Postoperative Computed Tomographic Angiography Scan Necessary?
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Journal Article
Early Follow-Up After Endovascular Aneurysm Repair: Is the First Postoperative Computed Tomographic Angiography Scan Necessary?
2012
Overview
Purpose
To examine whether initial postoperative computed tomographic angiography
(CTA) is needed in all patients undergoing endovascular aneurysm repair
(EVAR).
Methods
A total of 105 consecutive patients underwent EVAR with standard infrarenal
devices in our department between November 2009 and May 2011. Five patients
were excluded due to severe renal insufficiency, leaving 100 (85 men; median
age 73 years, range 46–91) eligible for prospective enrollment in a
triple-modality early postoperative follow-up protocol [intraoperative
completion angiography, postoperative duplex ultrasonography (DUS), and
plain abdominal radiography). Findings were compared for sensitivity,
specificity, positive predictive value (PPV), and negative predictive value
(NPV) against the first postoperative CTA results for the detection of
endoleaks or other signs of EVAR failure.
Results
There were 10 inconclusive DUS examinations. In the remaining 90 patients,
DUS had 75.0% sensitivity, 95.4% specificity, 85.7%
PPV, and 91.5% NPV for the detection of endoleaks. The intraoperative
angiogram, DUS, and abdominal radiograph combined resulted in 87.5%
sensitivity and 95.4% specificity, with a 65.6% PPV and
94.8% NPV for the detection of endoleaks. In 2 patients who required
a reintervention for endoleak in the early postoperative period, both
endoleaks were correctly detected by the triple-modality early postoperative
follow-up protocol.
Conclusion
An early follow-up protocol consisting of an intraoperative completion
angiogram, DUS, and abdominal radiograph shows a high sensitivity and NPV
for the detection of endoleaks and should detect early migration or kinking
of the stent-graft. An initial postoperative CTA is not necessary for most
patients undergoing EVAR and should be reserved for those individuals in
whom the aforementioned modalities are inconclusive or show signs of
endoleak or other EVAR failure.
Publisher
SAGE Publications,Allen Press Inc
Subject
/ Aged
/ Aortic Aneurysm - diagnostic imaging
/ Blood Vessel Prosthesis Implantation - adverse effects
/ Blood Vessel Prosthesis Implantation - instrumentation
/ Endoleak - diagnostic imaging
/ Endovascular Procedures - adverse effects
/ Endovascular Procedures - instrumentation
/ Female
/ Foreign-Body Migration - diagnostic imaging
/ Foreign-Body Migration - etiology
/ Foreign-Body Migration - surgery
/ Germany
/ Humans
/ Male
/ Software
/ Stents
