Godfrey Anthony D, Morbi Abigail H M, Nordon Ian M
Unit of Cardiac Vascular and Thoracic Surgery (CV&T), Department of Vascular Surgery, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK.
University of Southampton, Southampton, Hampshire, SO16 6YD, UK.
Cardiovasc Intervent Radiol. 2015 Oct;38(5):1130-6. doi: 10.1007/s00270-015-1073-8. Epub 2015 Mar 14.
Integral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.
Retrospective analysis of 179 consecutive elective EVAR cases [2008-2013] was performed. 167 patients were male, with the age range of 50-95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.
Fifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).
Compliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR.
完善的监测方案是维持血管内动脉瘤修复术（EVAR）后良好疗效的关键。相当一部分患者未能遵守监测要求，从而使自己面临并发症风险。我们对英国韦塞克斯郡的EVAR监测情况进行了研究，探讨可能预测依从性差的因素。
对2008年至2013年期间连续进行的179例择期EVAR病例进行回顾性分析。167例患者为男性，年龄在50至95岁之间。监测在中心（三级转诊创伤中心）和四个分支单位进行。对监测依从性以及不依从的预测因素进行分析，包括年龄、性别、合并症状态、居住地点和社会经济地位，以确定单因素的显著性。
50例患者（27.9%）未遵守监测要求；14例（8.1%）在EVAR术后未进行影像学检查。术后1年，123例患者中有56.1%依从监测。在术后第2年和第3年，65例和34例患者中分别有41.5%和41.2%依从监测。EVAR术后4年，8例患者中只有1例参加了监测（12.5%）。年龄（p = 0.77）、合并症状态或性别（p = 0.64）无统计学显著差异。到中心单位的距离（p = 0.67）和监测地点（p = 0.56）也无显著差异。虽然中上层社会经济群体有依从监测的趋势（ABC1组与C1C2D组相比），且超过50%的不依从患者居住在距中心单位半径10英里以内，但总体预测价值不显著（p = 0.82）。
EVAR术后监测的依从性较差。尚未证实有独立的不依从预测因素，但社会经济地位似乎与之相关。术后第一年之后的随访率令人担忧地下降。如果我们要维持EVAR术后的良好疗效，本研究凸显了一个亟待解决的问题。
