EVAR surveillance 'paradox', by George Antoniou.

George Antoniou

EVAR surveillance paradox

Manchester

EVAR is mainstay of rx for AAA

Long term RCT data states increased risk of reintervention, rutpure and aneuyrsm related mortality

Imaging intended to look at: Endoleak, migration, stent fracture, sac rupture.

O: to compar survival of pts who were EVAR surveillance compliant, compared to those who were not.

systematic search

Identified 13 studies

22,762 patients ; about half compliant

Most of the studies were in the USA. Almost all were retrospective studies.

Rx period range 1996 - 2020

Pooled all cause mortality

0.61 - 1.77 CI and diamond at 1.04 forest plot for all

p value 0.88

Pooled on aneurysm related mortality

no stats sig diff

p=0.12

non compliant pts had lower risk of rupture compared to those compliant at the margin of stats significant at p=0.05

GRADE = certainty of outcomes was very low for all papers

and all were observational papers

INTERPRETATION

complete EVAR surveillance does not prolong life expectancy

or

complete surveillance has positive outcome benefit but only in a subset of pts with specific characeristics

now doing a delphi study to come up with a risk-informed surveillance strategy

Q: was surveillance more important during the earlier yesars of the life cycle of EVAR?

A: did not really answer the qn initially. Then accepted merit on fu qn.