Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Objective: Lifelong surveillance is recommended for both endovascular aneurysm repair and acute, uncomplicated type B thoracic aortic dissection, though compliance remains a significant challenge. We sought to determine factors associated with failure to obtain recommended surveillance. Methods: Patients surviving to discharge who had endovascular repair of thoracic (thoracic endovascular aortic aneurysm repair [TEVAR]) or abdominal aortic aneurysms (endovascular aortic aneurysm repair [EVAR]) or medical management for type B dissections from 2004-2011 were reviewed. Primary end points were compliance with follow-up and need for reintervention. Comorbidities examined included coronary artery disease, congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and chronic kidney disease. Socioeconomic factors examined were age, sex, distance from hospital, discharge destination (ie, home or skilled nursing facility), and insurance type. Endoleak and sac expansion were recorded, as were complications, including endograft migration, infection or thrombosis, and aneurysm degeneration. Results: Two hundred four patients, median age 71.9 years, were identified; 171 had EVAR and 33 had type B dissection. EVAR patients included 45 thoracic, 100 abdominal, and 12 thoracoabdominal endografts, as well as 7 iliac artery aneurysm repairs and 7 proximal/distal graft extensions. Median follow-up was 28 ± 10.5 months. Overall, 56% were lost to follow-up, whereas 11% never returned for surveillance after initial hospitalization. Follow-up was compared for each of the comorbidities and socioeconomic factors; none were found to significantly affect follow-up. The known complication rate was 9.3% (n = 19), with reintervention performed in 14% of EVAR/TEVAR patients. Thirty-eight percent of medically managed patients with type B dissections eventually required surgical intervention. All-cause 5-year mortality was 27% as determined by the Social Security Death Index. Conclusions: Despite a significant rate of reintervention following EVAR, TEVAR, and type B dissection, long-term compliance with surveillance is limited. In addition, predicting who is at risk of being lost to follow-up remains difficult. If current recommendations for lifelong surveillance are to be followed, coordinated protocols are required to capture EVAR, TEVAR, and type B dissection patients to ensure optimal follow-up for these patients. However, the lack of survival benefit in those with complete follow-up suggests that further study is needed with regard to ideal duration of long-term follow-up.

Original languageEnglish (US)
Pages (from-to)25-32
Number of pages8
JournalJournal of Vascular Surgery
Volume58
Issue number1
DOIs
StatePublished - Jul 2013

Fingerprint

Aortic Aneurysm
Aneurysm
Dissection
Thoracic Aortic Aneurysm
Thorax
Lost to Follow-Up
Comorbidity
Iliac Aneurysm
Skilled Nursing Facilities
Endoleak
Social Security
Iliac Artery
Abdominal Aortic Aneurysm
Insurance
Chronic Renal Insufficiency
Chronic Obstructive Pulmonary Disease
Compliance
Coronary Artery Disease
Hospitalization
Thrombosis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

@article{2446e2c0786c4b2193839a57d20b0af6,
title = "Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection",
abstract = "Objective: Lifelong surveillance is recommended for both endovascular aneurysm repair and acute, uncomplicated type B thoracic aortic dissection, though compliance remains a significant challenge. We sought to determine factors associated with failure to obtain recommended surveillance. Methods: Patients surviving to discharge who had endovascular repair of thoracic (thoracic endovascular aortic aneurysm repair [TEVAR]) or abdominal aortic aneurysms (endovascular aortic aneurysm repair [EVAR]) or medical management for type B dissections from 2004-2011 were reviewed. Primary end points were compliance with follow-up and need for reintervention. Comorbidities examined included coronary artery disease, congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and chronic kidney disease. Socioeconomic factors examined were age, sex, distance from hospital, discharge destination (ie, home or skilled nursing facility), and insurance type. Endoleak and sac expansion were recorded, as were complications, including endograft migration, infection or thrombosis, and aneurysm degeneration. Results: Two hundred four patients, median age 71.9 years, were identified; 171 had EVAR and 33 had type B dissection. EVAR patients included 45 thoracic, 100 abdominal, and 12 thoracoabdominal endografts, as well as 7 iliac artery aneurysm repairs and 7 proximal/distal graft extensions. Median follow-up was 28 ± 10.5 months. Overall, 56{\%} were lost to follow-up, whereas 11{\%} never returned for surveillance after initial hospitalization. Follow-up was compared for each of the comorbidities and socioeconomic factors; none were found to significantly affect follow-up. The known complication rate was 9.3{\%} (n = 19), with reintervention performed in 14{\%} of EVAR/TEVAR patients. Thirty-eight percent of medically managed patients with type B dissections eventually required surgical intervention. All-cause 5-year mortality was 27{\%} as determined by the Social Security Death Index. Conclusions: Despite a significant rate of reintervention following EVAR, TEVAR, and type B dissection, long-term compliance with surveillance is limited. In addition, predicting who is at risk of being lost to follow-up remains difficult. If current recommendations for lifelong surveillance are to be followed, coordinated protocols are required to capture EVAR, TEVAR, and type B dissection patients to ensure optimal follow-up for these patients. However, the lack of survival benefit in those with complete follow-up suggests that further study is needed with regard to ideal duration of long-term follow-up.",
author = "Kret, {Marcus R.} and Amir Azarbal and Erica Mitchell and Timothy Liem and Gregory Landry and Moneta, {Gregory (Greg)}",
year = "2013",
month = "7",
doi = "10.1016/j.jvs.2012.12.046",
language = "English (US)",
volume = "58",
pages = "25--32",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Compliance with long-term surveillance recommendations following endovascular aneurysm repair or type B aortic dissection

AU - Kret, Marcus R.

AU - Azarbal, Amir

AU - Mitchell, Erica

AU - Liem, Timothy

AU - Landry, Gregory

AU - Moneta, Gregory (Greg)

PY - 2013/7

Y1 - 2013/7

N2 - Objective: Lifelong surveillance is recommended for both endovascular aneurysm repair and acute, uncomplicated type B thoracic aortic dissection, though compliance remains a significant challenge. We sought to determine factors associated with failure to obtain recommended surveillance. Methods: Patients surviving to discharge who had endovascular repair of thoracic (thoracic endovascular aortic aneurysm repair [TEVAR]) or abdominal aortic aneurysms (endovascular aortic aneurysm repair [EVAR]) or medical management for type B dissections from 2004-2011 were reviewed. Primary end points were compliance with follow-up and need for reintervention. Comorbidities examined included coronary artery disease, congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and chronic kidney disease. Socioeconomic factors examined were age, sex, distance from hospital, discharge destination (ie, home or skilled nursing facility), and insurance type. Endoleak and sac expansion were recorded, as were complications, including endograft migration, infection or thrombosis, and aneurysm degeneration. Results: Two hundred four patients, median age 71.9 years, were identified; 171 had EVAR and 33 had type B dissection. EVAR patients included 45 thoracic, 100 abdominal, and 12 thoracoabdominal endografts, as well as 7 iliac artery aneurysm repairs and 7 proximal/distal graft extensions. Median follow-up was 28 ± 10.5 months. Overall, 56% were lost to follow-up, whereas 11% never returned for surveillance after initial hospitalization. Follow-up was compared for each of the comorbidities and socioeconomic factors; none were found to significantly affect follow-up. The known complication rate was 9.3% (n = 19), with reintervention performed in 14% of EVAR/TEVAR patients. Thirty-eight percent of medically managed patients with type B dissections eventually required surgical intervention. All-cause 5-year mortality was 27% as determined by the Social Security Death Index. Conclusions: Despite a significant rate of reintervention following EVAR, TEVAR, and type B dissection, long-term compliance with surveillance is limited. In addition, predicting who is at risk of being lost to follow-up remains difficult. If current recommendations for lifelong surveillance are to be followed, coordinated protocols are required to capture EVAR, TEVAR, and type B dissection patients to ensure optimal follow-up for these patients. However, the lack of survival benefit in those with complete follow-up suggests that further study is needed with regard to ideal duration of long-term follow-up.

AB - Objective: Lifelong surveillance is recommended for both endovascular aneurysm repair and acute, uncomplicated type B thoracic aortic dissection, though compliance remains a significant challenge. We sought to determine factors associated with failure to obtain recommended surveillance. Methods: Patients surviving to discharge who had endovascular repair of thoracic (thoracic endovascular aortic aneurysm repair [TEVAR]) or abdominal aortic aneurysms (endovascular aortic aneurysm repair [EVAR]) or medical management for type B dissections from 2004-2011 were reviewed. Primary end points were compliance with follow-up and need for reintervention. Comorbidities examined included coronary artery disease, congestive heart failure, hypertension, chronic obstructive pulmonary disease, diabetes, and chronic kidney disease. Socioeconomic factors examined were age, sex, distance from hospital, discharge destination (ie, home or skilled nursing facility), and insurance type. Endoleak and sac expansion were recorded, as were complications, including endograft migration, infection or thrombosis, and aneurysm degeneration. Results: Two hundred four patients, median age 71.9 years, were identified; 171 had EVAR and 33 had type B dissection. EVAR patients included 45 thoracic, 100 abdominal, and 12 thoracoabdominal endografts, as well as 7 iliac artery aneurysm repairs and 7 proximal/distal graft extensions. Median follow-up was 28 ± 10.5 months. Overall, 56% were lost to follow-up, whereas 11% never returned for surveillance after initial hospitalization. Follow-up was compared for each of the comorbidities and socioeconomic factors; none were found to significantly affect follow-up. The known complication rate was 9.3% (n = 19), with reintervention performed in 14% of EVAR/TEVAR patients. Thirty-eight percent of medically managed patients with type B dissections eventually required surgical intervention. All-cause 5-year mortality was 27% as determined by the Social Security Death Index. Conclusions: Despite a significant rate of reintervention following EVAR, TEVAR, and type B dissection, long-term compliance with surveillance is limited. In addition, predicting who is at risk of being lost to follow-up remains difficult. If current recommendations for lifelong surveillance are to be followed, coordinated protocols are required to capture EVAR, TEVAR, and type B dissection patients to ensure optimal follow-up for these patients. However, the lack of survival benefit in those with complete follow-up suggests that further study is needed with regard to ideal duration of long-term follow-up.

UR - http://www.scopus.com/inward/record.url?scp=84879409963&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84879409963&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2012.12.046

DO - 10.1016/j.jvs.2012.12.046

M3 - Article

C2 - 23465175

AN - SCOPUS:84879409963

VL - 58

SP - 25

EP - 32

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 1

ER -