027 - Individualized follow-up stratified by type of device for patients post standard EVAR
Purpose: Endovascular Aneursym Repair is an accepted treatment method for selected patinets presenting with Abdominal Aortic Aneurysm (AAA). However, long-term results and device durability are problematic in some devices, already recognized by the FDA with warnings issued fo r he treatment using specific devices. For the Endologix AFX plus Vela the problem of component separation is a specific complication with the risk of acute AAA rupture.
Material and Methods: All patients who underwent standard EVAR using an Endologix AFX plus vela device between October 2015 and September 2022 were actively recalled and underwent physical examination , plain abdominal X-ray and CT Angiography .
Results: Between 10/2015 and 09/2022 a total of 556 patients underwent open surgical or endovascular treatment for AAA. 323 patients underwent open surgery and 233 patients standard EVAR. For EVAR an Endologix AFX system using 2 components was implanted in 26 selected patients with a narrow aortic bifurcation (21 men, 5 women, mean age 75.6 + 5.9 years). No intra- or perioperative mortality occurred. During follow-up 11 patients (11/26=42%) died after a median follow-up of 23 months (range 1-49 months), of these one patient post 49 months due to confirmed AAA rupture due to component dislocation. 3 patients are lost to follow-up. Median survival in the 12 patients alive is 54 months. In 4 patients the AAA is shrinking, in 4 patients stable but not shrinking, in 3 patients growing under surveillance, and in one patient successful relining to treat component separation was performed 68 months post primary implantation. 15 of the 26 patients did not adhere to the given follow-up schedule, and did not present for the appointments scheduled. This may be exaggerated by the COVID-19 pandemic. Regarding the radiologic follow-up, the Endologix device causes severe artefacts in Magnetic Resonance Imaging and requires computertomographic controls if aneurysm growth is suspected. Also plain X-rays for detection of device or component migration gain importance.
Conclusions: Life-long follow-up post EVAR is important. A strategy needs to be developed by the centers implanting EVAR devices to ensure that patients follow the appointments and radiographic controls. A device-specific follow-up plan needs to be developed as some implants show specific risks during long-term treatment, and its implementation in AAA treatment guidelines should be considered.