St George's Vascular Institute, St George's University Hospital NHS Foundation Trust, London, UK; Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
St George's Vascular Institute, St George's University Hospital NHS Foundation Trust, London, UK.
Eur J Vasc Endovasc Surg. 2019 Apr;57(4):521-526. doi: 10.1016/j.ejvs.2018.10.032. Epub 2019 Feb 6.
Surveillance imaging is considered mandatory after endovascular aneurysm repair (EVAR), but many patients are lost to follow up and the impact of this is poorly understood. This study aimed to examine compliance with post-operative surveillance in the UK and the impact of mal-/non-compliance on endograft re-interventions and survival.
EVAR-SCREEN centres reported EVAR for intact infrarenal abdominal aortic aneurysms (AAA) from 1 January 2007 to 31 December 2010, with follow up included up to 31 July 2014. Non-compliance was defined by the presence of a single 18 month period in which no surveillance imaging was performed. The outcomes were reported in compliant and non-compliant groups with survival analysis.
EVAR was performed in 1414 patients in 10 UK centres. At the end of the study period there were 378 patients with five years of follow up available for analysis. Compliance with surveillance was 66% (61-68%). Compliance varied widely, from 9% to 88% between centres. Age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01-1.05; p = .02) and distance from hospital (HR 1.01, 95% CI 1.00-1.01; p < .001) were independent predictors of non-compliance. Non-compliant patients had lower all cause mortality in the first three years after EVAR, whereas compliant patients had lower all cause mortality 4-5 years after EVAR (p < .001). No significant difference in re-intervention rates was found between compliant and non-compliant patients.
A substantial proportion of patients were non-compliant with surveillance after EVAR in the UK with considerable variation between centres. The survival benefit for EVAR after three years appeared to be related to compliance with surveillance which has implications for the future delivery of EVAR.
血管内动脉瘤修复（EVAR）后，监测成像被认为是强制性的，但许多患者失去了随访，其影响也未得到充分了解。本研究旨在检查英国术后监测的依从性，以及不遵守/不遵守监测对移植物再干预和生存率的影响。
EVAR-SCREEN 中心报告了 2007 年 1 月 1 日至 2010 年 12 月 31 日期间完整的肾下腹部主动脉瘤（AAA）的 EVAR，随访时间截至 2014 年 7 月 31 日。不遵守定义为存在单个 18 个月的时间段，在此期间未进行任何监测成像。根据生存分析，在符合和不符合条件的组中报告了结果。
10 个英国中心的 1414 名患者进行了 EVAR。在研究期末，有 378 名患者有五年的随访资料可供分析。监测的依从性为 66%（61-68%）。依从性差异很大，中心之间的依从率从 9%到 88%不等。年龄（风险比[HR] 1.03，95%置信区间[CI] 1.01-1.05；p=0.02）和距医院的距离（HR 1.01，95%CI 1.00-1.01；p<0.001）是不遵守的独立预测因素。EVAR 后前三年，不遵守患者的全因死亡率较低，而符合患者的 EVAR 后 4-5 年全因死亡率较低（p<0.001）。在符合和不符合条件的患者之间，再干预率没有发现显著差异。
英国 EVAR 后，相当一部分患者不符合监测要求，且各中心之间存在较大差异。EVAR 三年后生存获益似乎与监测依从性有关，这对未来 EVAR 的实施具有影响。
