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Compliance With Long-Term Surveillance Recommendations Following Endovascular Aneurysm Repair or Type B Aortic Dissection
Study Questions:
What are the frequency and predictors of incomplete follow-up after endovascular aortic aneurysm repair or type B aortic aneurysms?
Methods:
This retrospective single-center study examined 204 patients surviving to discharge after endovascular thoracic or abdominal aortic aneurysm repair (n = 171) or medically managed type B aortic dissection (n = 33), and assessed rates of follow-up and predictors of incomplete follow-up. Patients with type A aortic dissection were excluded from the study. The primary endpoints were length of follow-up and need for re-intervention; patient comorbidities, potential predictors of incomplete follow-up, complications, and all-cause mortality were also evaluated. Incomplete follow-up was defined as the most recent imaging or clinic visit >1 year prior to date that follow-up was assessed.
Results:
Median age was 71.9 years and 79.4% were men. Median follow-up was 28.0 ± 10.5 months. Incomplete follow-up was observed in 55.9% (n = 114) of patients, and 11.3% (n = 23) of patients had no follow-up after discharge. The presence of comorbidities such as coronary artery disease, heart failure, hypertension, diabetes, or renal disease was not associated with a difference in follow-up duration (p = not significant [NS] for each). Further, demographics such as distance from home to hospital, age, gender, marital status, insurance type, or discharge disposition were not associated with duration of follow-up (p = NS for each). Patients with a documented aortic complication had a trend to a longer follow-up than those without (39.5 ± 14.3 vs. 22.1 ± 9.5 months, p = 0.05). During follow-up of endovascular aneurysm repair, observed complications included endoleak (21.6%), aneurysm sac expansion (11.7%), infection/thrombosis (2.3%), and need for re-intervention (14.0%); during follow-up for medically managed type B aortic dissection, aneurysmal degeneration occurred in 30.3%, and subsequent intervention occurred in 38.2%. Overall, all-cause 5-year mortality was 26.8%, and patients with incomplete follow-up had longer mean survival as compared to those with complete follow-up (10.5 ± 2.1 vs. 7.4 ± 0.5 years, p < 0.001).
Conclusions:
Although the rates of complications and mortality are high following endovascular aortic repair or medically managed type B aortic dissection, a majority of patients appear to have incomplete follow-up. Patient demographics, comorbidities, and distance do not appear to be associated with patterns of follow-up.
Perspective:
Despite the high rates of mortality and complications following endovascular aortic repair or medically managed type B aortic dissection at this single center, a majority of patients had incomplete follow-up, even during the short duration of the study. Given recommendations for lifelong follow-up, and the tendency for follow-up rates to decrease over time, the problem may in fact be even worse than these data suggest. As it is possible that some patients lost to follow-up may have established care at other centers, and as examined variables were not associated with duration of follow-up, future study may be useful that directly queries patients about potential local follow-up and reasons for incomplete follow-up. In the meantime, it may be useful to develop means to improve rates of follow-up in these high-risk individuals.
Keywords: Coronary Artery Disease, Follow-Up Studies, Demography, Comorbidity, Vascular Surgical Procedures, Endoleak, Marital Status, Thrombosis, Heart Failure, Diabetes Mellitus, Hypertension
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