The Durability of Evar — What are the Evidence and Implications on Follow-Up?

• Published in: Scandinavian journal of surgery Vol. 97; no. 2; pp. 205 - 212
• Main Authors: Lange, C., Aasland, J. K., Ødegård, A., Myhre, H. O.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-01-2008
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - therapy; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Satisfaction; Stents - adverse effects; follow-up; endovascular; EVAR; secondary procedures; Abdominal aortic aneurysm; durability
• ISSN: 1457-4969; 1799-7267
• DOI: 10.1177/145749690809700227

Background and Aims:
To investigate the durability of EVAR and to explore the evidence for follow-up investigations. Furthermore, to study the patients' impressions of follow-up investigations, and how complications and secondary procedures influence cost-effectiveness.
Material and Methods:
263 patients were treated by EVAR from february 1995-february 2007. The series is divided into two groups with the year 2000 as a cut-off point since a new generation of stent grafts was then introduced. Early and late complications and secondary procedures were recorded. A questionnaire study was performed to investigate the patients' views on the follow-up program.
Results:
There was a significant reduction of complications from period I to period II, which was also reflected in the reduction of secondary procedures. Freedom from secondary procedures were 47% and 93% at 5 years follow-up in the two periods, respectively. In phase II, 7.5% of the patients needed a secondary procedure. Limb extension and femoro-femoral bypass were the most common procedures. Since late complications still occur, and can be unpredictable, a follow-up program is necessary. The vast majority of the patients tolerated the follow-up program well.
Conclusions:
Although the number of complications following EVAR has decreased significantly over the years, a thorough follow-up program is still necessary. This follow-up regime is well tolerated by the patients. Reduction of secondary procedures is important to improve the cost-effectiveness of EVAR.