Do we need long-term follow-up after EVAR and TEVAR or can we simplify surveillance protocols?

Endovascular repair is an increasingly preferred treatment modality for aortic pathology. Concerns regarding durability and postimplant complications have let to recommendations for rigorous surveillance regimens which are not entirely data-driven. Besides the costs of an excessive imaging follow-up protocol, deleterious effects may arise from repeated contrast administration and radiation exposure. Due to improvements in selection, planning and execution, coupled with technical improvements in devices, reported complications following endovascular repair have gradually decreased since the pivotal reports. Although late failure may be multifactorial and therefore not totally preventable with any surveillance regimen, patients may be stratified according to the expected risk (balanced by the potential benefit gained with surveillance) and be offered an individualized surveillance program. In this review, we aimed to describe current strategies for surveillance, modern outcomes after abdominal and thoracic endovascular repair, and proposed risk-adapted strategies for postoperative surveillance.

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