Follow up Imaging Protocols after Endovascular Aneurysm Repair: Results of the International FOREVAR Survey.
Description
European Vascular Research Collaborative: Vaiva Dabravolskaite, Christian Zielasek, Salome Weiss
Publisher DOI
PubMed ID
41541074
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.
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.
Date Issued
2025
Publication Type
Article
Subjects
Endovascular aortic repair
•
Follow up imaging
•
Protocol
•
Survey
•
Vascular surgery
Language(s)
en
Author(s)
Tran, Bich L | |
Zwetsloot, Sabrina L M | |
Teraa, Martin | |
Lareyre, Fabien | |
Kukulski, Leszek | |
Jongkind, Vincent |
Additional Credits
Journal
EJVES Vascular Forum
Publisher
Elsevier
ISSN
2666-688X
Access(Rights)
open.access