Z. C. Ballinger1, R. LaGrone3, Z. Novak2, E. Spangler2 1University Of Alabama at Birmingham, School Of Medicine, Birmingham, Alabama, USA 2University Of Alabama at Birmingham, School Of Medicine, Department Of Surgery, Division Of Vascular Surgery And Endovascular Therapy, Birmingham, Alabama, USA 3University Of Massachusetts Medical School, Department Of Surgery, Worcester, MA, USA
Introduction: Endovascular aneurysm repair (EVAR) is used to treat the majority of abdominal aortic aneurysms (AAA) in the US. While EVAR has a lower perioperative mortality rate, it has associated long-term risks and complications – the most important among these being endoleak and late rupture; long-term imaging surveillance occurring at least yearly is critical to monitor for these late complications. Patients and providers face challenges, potentially including socioeconomic factors, in maintaining this surveillance.
Methods: A retrospective chart review of 377 patients with an infrarenal EVAR between 2010-2020 at an academic medical center was conducted. Imaging and mortality dates were analyzed to determine which patients were up-to-date with surveillance imaging receipt as of July 1, 2022. We defined noncompliance as any period following EVAR during which an 18-month or more gap in imaging was present. State Area Deprivation Index (ADI), derived from 9-digit zip codes, ranked socioeconomic disadvantage on a decile scale of 1 (least disadvantaged) to 10 (most disadvantaged). State ADIs were grouped into tertile 1 (1-3), Tertile 2 (4-7), and tertile 3 (7-10). Descriptive analytics of the cohort were performed and Kaplan-Meier analysis examined freedom from gaps in imaging surveillance across ADI.
Results: Median age of our cohort was 71±9 years, 84.8% (N=320) were male, and 10.6% were non-white. Using the data gathered, we determined that 42.4% of our patients were up to date with imaging as of July 2022. Our cohort had ADI ranging across all state deciles, with a mean ADI of 4.83±2.8; 60.8% of our cohort had an ADI of less than 5. Patients with the greatest socioeconomic disadvantage (tertile 3) had better receipt of long-term imaging follow-up than patients with less socioeconomic disadvantages in tertiles 1 and 2, however, there was not a statistically significant association between socioeconomic deprivation and imaging follow-up (Figure, log-rank p=.29 from 18-month gaps in surveillance by tertiles).
Conclusion: The results of this study suggest that surveillance imaging at our tertiary medical center is similar to previously published estimates of surveillance imaging compliance after EVAR. Surprisingly, markers of increased socioeconomic deprivation did not correlate with worse receipt of imaging surveillance after EVAR at our tertiary academic medical center.
