CT Scans Are Overused In The Follow-Up Of EVAR: Many Can Be Omitted Or Replaced By Duplex Saving Dollars And Decreasing Radiation Exposure

Main Category: Cardiovascular / Cardiology
Also Included In: MRI / PET / Ultrasound;  Radiology / Nuclear Medicine
Article Date: 24 Nov 2008 - 12:00 PDT

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Long term surveillance with computed comography (CT) after endovascular aneurysm repair (EVAR) increases both cost and risk. The purpose of a study presented by Michael S. Makaroun, M.D., Professor of Surgery and Chief, Division of Vascular Surgery at the University of Pittsburgh Medical Center, was to evaluate an alternative follow-up modality with color flow duplex ultrasound scanning (CDU) as the sole method of imaging.

Currently most practices follow the manufacturer's recommend schedules. Dr. Makaroun stated that the community needs to rethink the schedules, because EVAR very expensive and a good part of that expense is from CT charges.

Also, the use of CT scanning has had an over 600% increase, with abdominal CT scans even higher, leading to a much greater exposure to radiation.

CDU is cheaper and safer, but needed to be testing to ensure patient safety. In 2003, Dr. Makaroun initiated a new followup (FU) schedule with yearly CDU as the sole imaging method for selected patients. Indications included a residual sac of less than 4cm, expanded later to stable sac size for more than 2 years. A stable type II endoleak was not a contraindication. CT scans were obtained selectively based on suspicious findings of a new endoleak or enlarging sac on CDU. The records of all patients with at least one year FU under this schedule were reviewed.

Dr. Makaroun was able to conclude that CDU only surveillance post-EVAR is safe and can be initiated early after treatment in patients with shrinking or stable aneurysms. He feels strongly that this policy should result in cost savings advantage and avoid the complications associated with CT.

VEITH SYMPOSIUM - New York, November 19th to 23rd

Now in its fourth decade, VEITH SYMPOSIUM provides vascular surgeons, interventional radiologists, interventional cardiologists and other vascular specialists with a unique and exciting format to learn the most current information about what is new and important in the treatment of vascular disease. The 5-day event features rapid-fire presentations from world renowned vascular specialists with emphasis on the latest advances, changing concepts in diagnosis and management, pressing controversies and new techniques.

VEITHsymposium is sponsored by Cleveland Clinic, Cleveland, OH.

www.veithsymposium.org

Source
Pauline T. Mayer
www.ptmhcm.com

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