Abdominal Aortic Aneurysm (Repair Follow-up)
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Population Covered By The Guidance
This pathway provides guidance for imaging follow-up of adult patients following endovascular abdominal aortic aneurysm repair (EVAR).
Date reviewed: May 2018
Date of next review: April 2023
Published: June 2018
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
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None | 0 |
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Minimal | < 1 millisieverts |
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Low | 1-5 mSv |
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Medium | 5-10 mSv |
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High | >10 mSv |
Teaching Points
Teaching Points
- Endoleaks occur in 15-25% of patients within the first 30 days of EVAR and are often asymptomatic 1
- Type II endoleaks are the most common and often spontaneously occlude. 2 Type I and III endoleaks are associated with an increased risk of rupture 3 and are usually managed promptly 4
- An early one-month postoperative study is done to assess adequacy of AAA exclusion, baseline endograft positioning and AAA size. If no endoleak is detected, subsequent studies may be performed annually 5
- Delayed endoleaks may occur months or years after EVAR so lifetime surveillance is recommended. 5 The incidence of delayed complications requiring treatment is about 3% 6, 7
- Annual duplex ultrasound is most likely sufficient for routine surveillance in the absence of new endoleak or sac enlargement, and eliminates radiation exposure, reduces cost and avoids use of contrast 5
- CTA is used if sac is increasing or duplex suggests an endoleak 5
References
References
Date of literature search: March 2018
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Dias NV, Riva L, Ivancev K, Resch T, Sonesson B, Malina M. Is there a benefit of frequent CT follow-up after EVAR? Eur J Vasc Endovasc Surg. 2009;37(4):425-30. (Level III evidence). View the reference
- Liaw JV, Clark M, Gibbs R, Jenkins M, Cheshire N, Hamady M. Update: complications and management of infrarenal EVAR. Eur J Radiol. 2009;71(3):541-51. (Review article). View the reference
- Mehta M, Paty PS, Roddy SP, Taggert JB, Sternbach Y, Kreienberg PB, et al. Treatment options for delayed AAA rupture following endovascular repair. J Vasc Surg. 2011;53(1):14-20. (Level III evidence). View the reference
- Hallett RL, Ullery BW, Fleischmann D. Abdominal aortic aneurysms: pre- and post-procedural imaging. Abdominal radiology (New York). 2018 (Review). View the reference
- Chaikof EL, Dalman RL, Eskandari MK, Jackson BM, Lee WA, Mansour MA, et al. The society for vascular surgery practice guidelines on the care of patients with an abdominal aortic aneurysm. J Vasc Surg. 2018;67(1):2-77.e2. (Guideline). View the reference
- Hiramoto JS, Reilly LM, Schneider DB, Sivamurthy N, Rapp JH, Chuter TA. Long-term outcome and reintervention after endovascular abdominal aortic aneurysm repair using the Zenith stent graft. J Vasc Surg. 2007;45(3):461-5; discussion 5-6. (Level II evidence). View the reference
- Vallabhaneni SR, Harris PL. Lessons learnt from the EUROSTAR registry on endovascular repair of abdominal aortic aneurysm repair. Eur J Radiol. 2001;39(1):34-41. (Level II evidence). View the reference
- Back MR. Surveillance after endovascular abdominal aortic aneurysm repair. Perspect Vasc Surg Endovasc Ther. 2007;19(4):395-400; discussion 1-2. (Review article). View the reference
- Hiatt MD, Rubin GD. Surveillance for endoleaks: how to detect all of them. Semin Vasc Surg. 2004;17(4):268-78. (Review article). View the reference
- Chisci E, Setacci F, Iacoponi F, de Donato G, Cappelli A, Setacci C. Surveillance imaging modality does not affect detection rate of asymptomatic secondary interventions following EVAR. Eur J Vasc Endovasc Surg. 2012;43(3):276-81. (Level III evidence). View the reference
- Roos JE, Hellinger JC, Hallet R, Fleischmann D, Zarins CK, Rubin GD. Detection of endograft fractures with multidetector row computed tomography. J Vasc Surg. 2005;42(5):1002-6. (Level V evidence). View the reference
- Wolf YG, Johnson BL, Hill BB, Rubin GD, Fogarty TJ, Zarins CK. Duplex ultrasound scanning versus computed tomographic angiography for postoperative evaluation of endovascular abdominal aortic aneurysm repair. J Vasc Surg. 2000;32(6):1142-8. (Level III evidence). View the reference
- Sun Z. Diagnostic value of color duplex ultrasonography in the follow-up of endovascular repair of abdominal aortic aneurysm. J Vasc Interv Radiol. 2006;17(5):759-64. (Review article). View the reference
- Zaiem F, Almasri J, Tello M, Prokop LJ, Chaikof EL, Murad MH. A systematic review of surveillance after endovascular aortic repair. J Vasc Surg. 2018;67(1):320-31.e37. (Review article). View the reference
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Information for Consumers
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Contrast Medium (Gadolinium versus Iodine) Iodine-Containing Contrast Medium Radiation Risk of Medical Imaging During Pregnancy Radiation Risk of Medical Imaging for Adults and Children |
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