Management of Infrarenal Abdominal Aortic Stent Graft with Stable Excluded Aneurysm

Surveillance Protocol After EVAR

The American College of Cardiology recommends continued surveillance with annual duplex ultrasound and additional cross-sectional imaging every 5 years for patients with stable excluded aneurysms without evidence of endoleak 1, 2
Annual duplex ultrasound surveillance is recommended to monitor for development of endoleaks, changes in aneurysm sac size, stent graft patency, and stent migration or kinking 1, 2, 3
Cross-sectional imaging with CT or MRI every 5 years is recommended to assess stent integrity, evaluate for subtle endoleaks, and check for stent migration or fracture 1, 2, 4

Immediate additional cross-sectional imaging with CT or MRI is indicated if any of the following are detected on surveillance ultrasound: endoleak, aneurysm sac enlargement, stent migration, kinking of the stent graft, or decreased flow in the stent graft 1, 2, 3, 4
The risk of late aortic rupture after EVAR is >5% through 8 years of follow-up, emphasizing the need for continued surveillance 1

The 2022 ACC/AHA guidelines recommend annual duplex ultrasound with additional cross-sectional imaging every 5 years for patients with stable EVAR repairs, with a strength of evidence considered high 1, 2
Duplex ultrasound has been shown to be highly specific for detection of type I and type III endoleaks and is 95% accurate for measuring aneurysm sac diameter, with a moderate level of evidence 1

Discontinuing surveillance prematurely is not recommended, as lifelong surveillance is necessary after EVAR due to the potential for late complications, with a high strength of evidence 3
Relying solely on ultrasound for the entire follow-up period is not recommended, as ultrasound may miss stent migration, fracture, or non-contiguous aneurysms, with a moderate level of evidence 1