Simplifying post-EVAR surveillance.

Surveillance after endovascular aneurysm repair (EVAR) is costly and a burden for the patient. Imaging is performed to detect stent-graft failure from endoleak or haemodynamic obstruction. Presently, computed tomographic angiography (CTA) is considered the gold standard for post-EVAR surveillance, as it has the potential to visualise most threats to stent-graft durability, such as migration, kinking, structural disintegration, endoleaks and aneurysm growth. Serious drawbacks of serial CTA, apart from its costs, are the risks of contrast-induced nephropathy and carcinogenesis from cumulative radiation exposure. Therefore, less invasive surveillance imaging techniques have been introduced, although none of these individually offers the ability to visualise all of the above signs of stent-graft failure. In the present observational study, Harrison and coworkers retrospectively investigated the results of a change in EVAR follow-up, replacing their original extensive protocol of serial, single-arterial-phase CTA, duplex ultrasound (DUS) and plain abdominal radiography (AXR) by the combination of DUS and AXR, with CTA performed only when problems were identified or DUS was not diagnostic. After a 4-year-period with 412 annual imaging sets in a series of 194 patients, the cumulative freedom of CTA was 65%. Eighteen out of 30 abnormalities found with the DUSeAXR combination were reconfirmed by CTA, resulting in a positive predictive value of 60%. In absence of a control