Editor's Choice - Implementation of the Updated European Society for Vascular Surgery Proposed Endovascular Aneurysm Repair Surveillance Algorithm in a Multicentre Cohort with a Minimum Five Year Follow Up Adherence: Further Improvement of Results via One Year Sac Dynamics.

OBJECTIVE

This multicentre, retrospective, observational study aimed to identify patients who are suitable for less frequent follow up (FU) checkups after endovascular aneurysm repair (EVAR) through the validation and implementation of the recently updated European Society for Vascular Surgery (ESVS) surveillance algorithm.

METHODS

An analysis was performed on consecutive patients who underwent EVAR for abdominal aortic aneurysm (AAA) at four high volume centres that demonstrated adherence to FU for at least five years. Patients were divided into high and low risk of adverse event groups, according to ESVS definitions, and compared. A sub-analysis was conducted for patients categorised as low risk who exhibited sac regression and no evidence of endoleak at the one year FU assessment.

RESULTS

Of 596 patients meeting the inclusion criteria, 300 (50.3%) fulfilled the ESVS criteria for classification as low risk. At the five year FU, the rates of rupture (0.7% vs. 3%; p = .031), AAA related death (0.7% vs. 2.4%; p = .089), and re-intervention (9.7% vs. 17.2%; p = .007) were lower in the low risk group. Over the initial five years of FU, 84 patients experienced adverse events such as re-interventions, ruptures, and or AAA related death, with 28 occurring in the ESVS low risk group, indicating that the ESVS protocol has a five year capability of predicting 90.7% of potential adverse events in low risk patients. The sub-analysis of ESVS low risk patients who exhibited sac regression and no evidence of endoleak at one year FU (20.1% of the total cohort) revealed a five year modified ESVS protocol capability of potentially predicting 97.6% of adverse events (three re-interventions recorded).

CONCLUSION

The updated ESVS surveillance algorithm provides a consistent prediction of potential adverse events within five years of FU, although refining patient stratification may further improve outcomes. Patients initially classified as low risk and also exhibiting sac regression without endoleaks at one year could be candidates for reduced surveillance.