Follow up Imaging Protocols after Endovascular Aneurysm Repair: Results of the International FOREVAR Survey
Year: 2025
Type: article
Study design: Observational Study
Abstract: Objective: Endovascular repair for aortic aneurysms necessitates routine follow up due to potential late complications, such as endograft occlusions, endoleaks, and late aneurysm rupture. Guidelines recommend periodic post-operative imaging, including computed tomography angiography (CTA) or duplex ultrasound, to monitor aneurysm status and stent integrity. The efficacy of these follow up protocols is controversial, with concerns about increased healthcare costs and patient morbidity. This survey aimed to assess global variance in follow up imaging protocols among vascular surgeons, interventional radiologists, and vascular surgery trainees. Methods: A global English web based survey was conducted over nine months and distributed through email, social media, and direct messaging to vascular surgeons, interventional radiologists, and other vascular specialists. Procedure specific questions included imaging techniques used and follow up duration. Results: The FOREVAR Survey was completed by 693 respondents from 65 countries. Most participants reported having a standardised follow up imaging protocol following all, or nearly all, elective endovascular aneurysm repairs (EVAR) in their centre (98%). The follow up protocols displayed substantial variation. In addition to completion angiography, other imaging was often performed before discharge (cone beam computed tomography 11%, CTA 27%, or DUS 17%). CTA is most often performed at first follow up (63%), while DUS is most frequently used during later follow up (56%). Median intervals to follow up imaging were eight weeks (first), 39 weeks (second), and 52 weeks (third). Follow up never ceased in 51% of cases. Comparable results were reported for complex EVAR (cEVAR) and thoracic EVAR (TEVAR), but with a greater proportion of patients receiving CTA after cEVAR at long term follow up (74%). Magnetic resonance imaging was used by a minority in the follow up of EVAR, cEVAR, and TEVAR (4%, 1%, and 4%, respectively). Conclusions: This global survey showed substantial variation in follow up imaging protocols after EVAR, cEVAR, and TEVAR. Most of these protocols lead to long term radiation exposure during follow up.
Source: EJVES Vascular Forum
Authors: Bich L. Tran, Sabrina L.M. Zwetsloot, Martin Teraa, Fabien Lareyre, Leszek Kukulski, Vincent Jongkind, Alexandra Gratl, Florian Enzmann, Gert J. de Borst, Lewis Meecham, Stefano Ancetti, Paolo Spath, Albert Busch, Bergrós Jóhannesdóttir, Alexander Gombert, Mohammad E. Barbati, Panagiotis Doukas, Katariina Noronen, Robert Hinchliffe, Alexandru Predenciuc, Qasam Ghulam, Angelos Karelis, Maram Darwish, Cecilie Markvard Møller, Matt Spreadbury, Willemien van de Water, Desiree van den Hondel, Alexander Croo, Gilles Uijtterhaegen, Ryan Gouveia e Melo, Vaiva Dabravolskaite, Christian Zielasek, Salome Weiss, Vishal Amlani, Aoife Kiernan, Petar Zlatanovic, Nikolaos Patelis, Max Hoebink, Harm Ebben, Kak Khee Yeung
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,045
OpenAlex ID: W4412704273