Long-term follow-up after endovascular aneurysm repair: is ultrasound alone enough?

In the last decade, endovascular aneurysm repair (EVAR) has become the preferred method for infrarenal abdominal aortic aneurysm repair in patients with suitable anatomy. EVAR offers the advantage of lower perioperative morbidity and mortality but carries the cost of device-related complications such as endoleak, graft migration, graft thrombosis, and structural graft failure. These complications mandate a lifelong surveillance of EVAR patients and their endografts. Since the advent of EVAR, this has largely been accomplished with serial computed tomography (CT). There is, however, increasing awareness of the risks and costs of a lifelong CT imaging mandate, which has led to several cohort analyses comparing CT with color duplex ultrasonography (CDU) with contrast-enhanced ultrasound (CEUS) for the evaluation of the endograft and aneurysm sac post-EVAR. This review will summarize the findings of these reports and highlight the results of recent ultrasound-based surveillance strategies.