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Meta-Analysis
. 2019 Aug;26(4):531-541.
doi: 10.1177/1526602819852085. Epub 2019 May 29.

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

Sylvana M L de Mik  1 , Anna C M Geraedts  1 , Dirk T Ubbink  1 , Ron Balm  1
Affiliations
Meta-Analysis

Effect of Imaging Surveillance After Endovascular Aneurysm Repair on Reinterventions and Mortality: A Systematic Review and Meta-analysis

Sylvana M L de Mik et al. J Endovasc Ther. 2019 Aug.

Abstract

Purpose: To study the effects of imaging surveillance after endovascular aortic repair (EVAR) on reintervention and mortality. Materials and Methods: A systematic review was conducted comparing complication rates in EVAR patients compliant with the imaging surveillance protocol vs partially or noncompliant patients. Two authors independently selected articles and performed quality assessment and data extraction. Risk differences for reintervention and mortality between compliant and partially/noncompliant patients were meta-analyzed. The pooled risk difference (RD) is reported with the 95% confidence interval (CI). The review protocol is registered at Prospero (CRD42017080494). Results: A total of 11 cohort studies involving 21,838 patients were included. Studies differed in imaging, their surveillance protocols, and definitions of compliance subgroups. Median follow-up was 31.7 months (interquartile range 29.8, 49.3). The overall reintervention rate was 5%, while the overall mortality was 31%. The RD for the reintervention rate was 4% (95% CI 1% to 7%) in favor of partial/noncompliance [number needed to harm 25 (95% CI 14 to 100)], while mortality showed a nonsignificant RD of 12% (95% CI -2% to 26%) in favor of partial/noncompliance. Two studies reported that 41% to 53% of reinterventions were performed for complications detected through imaging surveillance; the other events were detected through patient symptoms. Conclusion: Patients who are compliant with imaging surveillance appear to undergo more reinterventions than those who are partially or noncompliant. However, imaging surveillance does not seem to protect against mortality. This suggests that the recommended yearly imaging surveillance may not be beneficial for all EVAR patients.

Keywords: abdominal aortic aneurysm; endovascular aneurysm repair; imaging; meta-analysis; mortality; reintervention; surveillance.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.
Figure 2.
Figure 2.
Forest plots of (A) reintervention rates and (B) secondary ruptures in compliant vs partially/noncompliant (“no compliance”) patients.
Figure 3.
Figure 3.
Forest plots of (A) all-cause mortality (all studies), (B) all-cause mortality (studies based on the compliance definition), and (C) aneurysm-related mortality in compliant vs partially/noncompliant (“no compliance”) patients.
Figure 4.
Figure 4.
Funnel plots of (A) reintervention rates and (B) mortality in compliant vs partially/noncompliant patients. RD, risk difference, SE, standard error.
See this image and copyright information in PMC

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