The durability of EVAR--what are the evidence and implications on follow-up?

Background And Aims: To investigate the durability of EVAR and to explore the evidence for follow-up investigations. Furthermore, to study the patients' impressions of followup investigations, and how complications and secondary procedures influence cost-effectiveness.

Material And Methods: 263 patients were treated by EVAR from February 1995-February 2007. The series is divided into two groups with the year 2000 as a cut-off point since a new generation of stent grafts was then introduced. Early and late complications and secondary procedures were recorded. A questionnaire study was performed to investigate the patients' views on the follow-up program.

Results: There was a significant reduction of complications from period I to period II, which was also reflected in the reduction of secondary procedures. Freedom from secondary procedures were 47% and 93% at 5 years follow-up in the two periods, respectively. In phase II, 7.5% of the patients needed a secondary procedure. Limb extension and femoro-femoral bypass were the most common procedures. Since late complications still occur, and can be unpredictable, a follow-up program is necessary. The vast majority of the patients tolerated the follow-up program well.

Conclusions: Although the number of complications following EVAR has decreased significantly over the years, a thorough follow-up program is still necessary. This followup regime is well tolerated by the patients. Reduction of secondary procedures is important to improve the cost-effectiveness of EVAR.