Surveillance of patients after abdominal aortic aneurysm repair with endovascular grafting or conventional treatment

At Nuremberg Southern Hospital we have been using endovascular therapy for aortic aneurysms for the past 3 years. Between August 1994 and August 1997, 193 patients with infrarenal aortic aneurysms were treated with endovascul ar stent grafts. Besides using commercially available modular systems of the Stenter type (M inTec/Vanguard*, Boston Scientific) we also participated in a multicenter s tudy impanting EGS devices (EVT in 65 patients). Follow-up examinations must strive to detect thrombolic complications as we ll as endoleaks with high sensivity and specificity. To avoid aneurysm rupt ure significant increase in aneurysm diameter must be detected in a timely fashion to select patients For additional corrective endovascular procedure s or conversion to open surgical therapy. A close follow-up regimen therefore is absolutely mandatory for all patient s undergoing endovascular aortic grafting, particularly when new prosthetic devices are being introduced. Prosthetic devices that have been adequately tested using controlled study designs and are commercially available may b e followed-up using a standardized follow up scheme as delineated. Particularly during the first postoperative year color duplex with use of a n intravenous ultrasound enhancing agent has been used successfully to dete ct even minor endoleaks originating from retrograde perfusion via aortic si de branches (lumbar or inferior mesenteric artery). Only patients with docu mented endoleaks or suspected outflow obstruction requiring further interve ntion need to undergo diagnostic arteriography. After conventional aneurysm repair yearly duplex scans are usually sufficie nt to follow the normal patient. Patients who have undergone endovascular t herapy, however need to be followed much closer using duplex as well as abd ominal CT scans. This will logically result in significantly higher follow up costs. Periinterventional costs of endovascular aortic reconstruction currently ex ceed those of conventional aortic repair by approximately 50 %. Given the c urrent health care finance situation It is questionable whether endovascula r therapy of abdominal aneurysm will become standard practice in Germany.