Long-term EVAR Surveillance — EECC MCQ

Correct answer: A — Yes — sac shrinkage without endoleak on serial CT indicates successful exclusion; surveillance intervals can be extended (from annual to 2-3 yearly) based on institutional protocols; however, lifelong surveillance is still recommended as late complications can occur

EVAR requires lifelong surveillance because late complications can occur years after implantation: type I endoleak (loss of seal at attachment zones), type II endoleak (branch vessel backflow), stent migration, limb occlusion, and sac re-expansion. However, the intensity of surveillance can be tailored: (1) first year: CT at 1 month and 12 months (detection of early endoleaks); (2) subsequent years: annual CT if stable; (3) if sac shrinking and no endoleak: interval can be extended to 2-3 yearly (some centres shift to duplex ultrasound as a radiation-free alternative for stable cases); (4) contrast-enhanced ultrasound (CEUS) is an emerging alternative to CT for endoleak detection. The ESC 2024 Aortic Disease Guidelines recommend lifelong surveillance post-EVAR but acknowledge that the optimal modality and frequency after stable 5-year outcomes are evolving toward less intensive protocols.

Reference: ESC (2024): Aortic Disease Guidelines