Abstract
Background: Endovascular aortic repair (EVAR) has become a valuable alternative to open repair (OR) in treating abdominal aortic aneurysms (AAA), in older patients, due to a significant reduction in perioperative mortality, recovery time, and immediate complication rates. However, EVAR is associated with higher rates of complications over time and thus requires radiological surveillance, and more frequent reinterventions than OR. Objective: Estimate the rates of reinterventions in patients treated at Oslo University Hospital, Aker, and further, the excess radiation exposure related to reinterventions after EVAR, both as a result of the intervention itself, and the increased frequency of radiological imaging surveillance. Material and Methods: A total of 257 patients were primarily treated for an asymptomatic AAA, with bifurcated stent graft at Oslo University Hospital, Aker between 29.05.2007 and 27.11.2018. 147 of which had any complication and 58 with the need for any reintervention. We calculated the mean effective dose (ED) for the reinterventions and the cumulative radiation exposure (CRE) for the all the radiologic examinations and interventions in all the patients exceeding regular follow-up regime due to any complication. Results: The reintervention rate in total was 22,6%, and 18,7% for endovascular reinterventions. The average first reintervention was performed 2,3 years after the EVAR procedure, and each complication required an average of 1,45 endovascular reinterventions. The mean ED of an endovascular reintervention was 46,3 mSv. The average CRE in patients with reinterventions was 123,5 mSv, and 53,1 mSv in patients treated conservatively. The mean difference between these groups constituted a difference in monthly exposure of 0,9 mSv/month. Conclusion: Both the detection and treatment of complications following EVAR will cause a significant, additional radiation burden on patients. How much the additional radiation dose will affect the patients is not yet clear and may be subject to further research.