Endovascular abdominal aortic aneurysm repair: Evaluation of outcomes and risks of postoperative surveillance

This thesis investigates the outcomes of patients who underwent endovascular aneurysm repair (EVAR) for an abdominal aortic aneurysm (AAA). The use of EVAR has been rapidly increased since the 1990s and is, compared to open surgical repair, less invasive and associated with a significant reduction in perioperative mortality. The potential disadvantage of EVAR is the need for lifelong imaging surveillance to detect endograft related complications. The main focus of this thesis is to establish the rationale behind the current post-EVAR follow-up regimen, and to examine whether the frequency of imaging surveillance can be safely reduced in a certain subgroup of patients. Risk stratification based on the results of the first postoperative imaging study following EVAR may improve patient outcomes, reduce overtreatment and costs, and may increase adherence among patients where strict follow-up is necessary.
The first part of this thesis focuses on clinical outcomes in patients with an AAA who underwent EVAR. The purpose of this section is to determine the effectiveness of the current follow-up regimen and to gain insight in how patients experience yearly imaging follow-up. The second part investigates complications and secondary interventions that occur after AAA repair, with the aim of improving postoperative care.