Department of Surgery, Vascular and Endovascular Surgery Unit, University of Siena, Viale Bracci, Siena, Italy.
Eur J Vasc Endovasc Surg. 2012 Mar;43(3):276-81. doi: 10.1016/j.ejvs.2011.11.020. Epub 2012 Jan 10.
Literature reports that surveillance imaging following endovascular aortic aneurysm repair (EVAR) gives rise to asymptomatic secondary interventions (SI) in 1.4-9% of cases. This retrospective study aimed to evaluate whether the modality of surveillance imaging influences the detection rate of asymptomatic SI.
Two EVAR surveillance protocols were compared at the same vascular centre. Protocol I, performed from January 2003 to December 2006, consisted of colour duplex ultrasound scan (CDU) plus CT angiography (CTA) 1 month after procedure and every 6 months thereafter. Protocol II, performed from January 2007 to June 2010, consisted of CDU plus CTA 1 month after operation and CDU plus plain abdominal films (XR) every 6 months thereafter. In the second protocol, CTA was carried out only during follow-up in specific conditions. The term 'asymptomatic SI' was used when the necessity for SI was detected by imaging alone on an elective basis, prior to development of any symptoms.
Enrolment included 376 and 341 consecutive patients with a mean follow-up of 1148 days (range 1-3204 days) and 942 days (range1-1512 days) in Protocols I and II, respectively (p < 0.001). Freedom rates from aneurysmal rupture, freedom from SI and detection rate for asymptomatic SI at 3 years were 98.3% and 98.7% (p = 0.456), 82% and 83.5%(p = 0.876) and 8.8% (n = 33/376) and 8.5%(n = 25/341) (p = 0.49) in Protocols I and II, respectively. Estimated comparison of the costs, radiation exposure and contrast used at 3 years in Protocol I versus Protocol II showed that Protocol II allowed for a three-, four- and six fold reduction in overall costs, radiation exposure and contrast used, respectively (p < 0.0001).
The detection rate of asymptomatic SI following EVAR is not affected by the type of surveillance imaging. A surveillance schedule based primarily on CDU and XR appears to be justified.
文献报道，血管内腹主动脉瘤修复术（EVAR）后监测成像会导致 1.4-9%的无症状性二次干预（SI）。本回顾性研究旨在评估监测成像方式是否会影响无症状性 SI 的检出率。
在同一家血管中心比较了两种 EVAR 监测方案。方案 I 于 2003 年 1 月至 2006 年 12 月实施，包括术后 1 个月进行彩色双功超声扫描（CDU）加 CT 血管造影（CTA），此后每 6 个月进行一次。方案 II 于 2007 年 1 月至 2010 年 6 月实施，包括术后 1 个月进行 CDU 加 CTA，此后每 6 个月进行 CDU 加腹部平片（XR）。在第二个方案中，仅在特定情况下，在随访中进行 CTA。当仅通过影像学在选择性基础上发现需要进行 SI 而无任何症状时，使用“无症状性 SI”一词。
纳入了 376 例和 341 例连续患者，方案 I 和 II 的平均随访时间分别为 1148 天（范围 1-3204 天）和 942 天（范围 1-1512 天）（p<0.001）。3 年时的动脉瘤破裂、无症状性 SI 及无症状性 SI 检出率的无事件率分别为 98.3%和 98.7%（p=0.456）、82%和 83.5%（p=0.876）和 8.8%（n=33/376）和 8.5%（n=25/341）（p=0.49）。方案 I 和 II 中，3 年时的成本、辐射暴露和造影剂使用情况的估计比较表明，方案 II 使总成本、辐射暴露和造影剂使用分别减少了 3、4 和 6 倍（p<0.0001）。
EVAR 后无症状性 SI 的检出率不受监测成像类型的影响。以 CDU 和 XR 为主要基础的监测方案似乎是合理的。
