Trattamento endovascolare degli aneurismi dell’aorta addominale, controllo ultrasonografico e TC a breve e medio termine, valutazione dei risultati e trattamento delle complicanze

Introduction: To date the contrast-enhanced CT scan is the recommended postoperative surveillance after endovascular aneurysm repair (EVAR). The radiation exposure and progressive renal function deleterious and cost improvement associated with this surveillance regimen represents the major problematic. We evaluated the safety and efficacy of new post-EVAR surveillance regimens. Methods: From January 2007 to February 2010, 176 patients with abdominal aortic aneurysm (AAA) were enrolled to a prospective study to receive EVAR e subsequently a new post-EVAR surveillance regimens. An aneurysm-related morbidity (ARM) variable was calculated to include open conversion, any secondary intervention, limb thrombosis and migration, aneurysm rupture, renal morbidity and aneurysm-related death. The long-term freedom from ARM as a function of the presence or absence of any endoleak at 3, 15, and 21 months was analyzed. The instructions for use for aortic neck anatomy (>10 mm length, <32 mm diameter, <80° angulation) were followed. Chi-Square tests for ARM data and time to event provided two-sided p values with a level of significance at 0.05 and all confidence interval (C.I.) at the 95% level. Survival curves for primary patency were plotted using Kaplan-Meier method. Results: EVAR was done in 176 patients (mean follow-up, 25 +/- 19 months). Freedom from endoleak at 3 month was highly predictive (p < 0.0001) of reduced ARM and of reduced reinterventio (p 0.0002). Cumulative absence of endoleak at 15 year was associated with absence of reintervention. Eighteen patients required an additional intervention. The overall ARM that required reoperation was 14,3% (14 endoleak, 4 limb thrombosis, 2 femoral pseudoaneurysm, 1 surgical conversion). Six cases of renal failure with need of dialysis occurred. Conclusions: Absence of endoleak at 3 months predicted greatly improved long-term freedom from ARM compared with early endoleak. A new EVAR surveillance regimen is recommended that modulates the intensity and frequency of postoperative imaging based on these early outcomes. In patients without early endoleak, the 3-15 months CT-scan surveillance is safe and efficacy, and 9-18 months ultrasound should be interposed for long-term surveillance >2 years. This reduced surveillance regimen seems to be appropriate and improve the patient safety. Also it reduces the cumulative contrast deleterious effects, radiation exposure and health care costs. Further studies are needed to validate the results.