The Society for Vascular Surgery guidelines recommend annual imaging surveillance following endovascular aneurysm repair (EVAR) and every 5 years following open surgical repairs (OSR) of abdominal aortic aneurysms (AAAs). Adherence to these guidelines is low outside of clinical trials, and compliance at Veterans Affairs (VA) hospitals is not yet well-established. We examined imaging follow-up compliance and mortality rates after AAA repair at VA hospitals. We queried the VA Surgical Quality Improvement Program database for elective infrarenal AAA repairs, EVAR and OSR, then merged in follow-up imaging and mortality information. Mortality rate over time was derived using Kaplan-Meier estimation. Generalized estimating equation with a logit link and a sandwich standard error estimate was performed to compare the probability of having annual follow-up imaging over time between procedure types and to identify variables associated with follow-up imaging for EVAR patients. Our analysis included 11,668 patients who underwent EVAR and 4507 patients who underwent OSR at VA hospitals between the years 2000 and 2019. The 30-day mortality rate for EVAR and OSR was 0.37% and 0.82%, respectively. OSR was associated with lower long-term mortality after adjusting age, sex, American Society of Anesthesiologists classification and preoperative renal failure with an adjusted hazard ratio of 0.88 (95% confidence interval, 0.84-0.92; < .01). Of surviving patients, the follow-up imaging rate was 69.1% by 1 year post-EVAR. The follow-up rate after 5 years was 45.6% post-EVAR compared with 63.6% post-OSR of surviving patients. A history of smoking or drinking, baseline hypertension, and known cardiac disease were independently associated with poor follow-up after EVAR. Patients undergoing elective open AAA repair in the VA hospital system had lower long-term mortality compared with patients who underwent endovascular repair. Compliance with post-EVAR imaging is low. Patient factors associated with poor post-EVAR imaging surveillance were smoking within the last year, excess alcohol consumption, and cardiac risk factors including hypertension, prior myocardial infarction, and congestive heart failure.

中文翻译：

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在退伍军人事务部医院接受腹主动脉瘤修复术的患者的随访依从性

血管外科学会指南建议血管内动脉瘤修复 (EVAR) 后每年进行一次影像学监测，腹主动脉瘤 (AAA) 开放手术修复 (OSR) 后每 5 年进行一次影像学监测。在临床试验之外，对这些指南的遵守率很低，退伍军人事务部 (VA) 医院的合规性也尚未确定。我们检查了 VA 医院 AAA 修复后的影像随访依从性和死亡率。我们查询了 VA 手术质量改进计划数据库中的选择性肾下 AAA 修复、EVAR 和 OSR，然后合并到随访影像和死亡率信息中。使用 Kaplan-Meier 估计得出随时间变化的死亡率。执行具有 Logit 链接和三明治标准误差估计的广义估计方程，以比较不同手术类型之间随时间推移进行年度随访成像的概率，并确定与 EVAR 患者随访成像相关的变量。我们的分析包括 2000 年至 2019 年间在 VA 医院接受 EVAR 的 11,668 名患者和接受 OSR 的 4507 名患者。EVAR 和 OSR 的 30 天死亡率分别为 0.37% 和 0.82%。调整年龄、性别、美国麻醉医师协会分类和术前肾功能衰竭后，OSR 与较低的长期死亡率相关，调整后的风险比为 0.88（95% 置信区间，0.84-0.92；< .01）。在幸存患者中，EVAR 后 1 年随访影像学率为 69.1%。 EVAR 后 5 年后的随访率为 45.6%，而 OSR 后存活患者的随访率为 63.6%。吸烟或饮酒史、基线高血压和已知心脏病与 EVAR 后随访不良独立相关。与接受血管内修复的患者相比，在 VA 医院系统中接受选择性开放 AAA 修复的患者的长期死亡率较低。 EVAR 后成像的依从性较低。与 EVAR 后影像监测不良相关的患者因素包括去年吸烟、过量饮酒以及心脏危险因素，包括高血压、既往心肌梗死和充血性心力衰竭。