Management of Aortic Sac Enlargement Following Successful EVAR in a Frail XXXX .

@entity1 @entity439 @entity1070
BACKGROUND: An enlarging @entity439 after @entity439 repair (EVAR) without @entity1070 is a clinical challenge. Management of this problem is guided by the current evidence for adequate EVAR follow up and recommended thresholds for re-intervention. In a frail @entity1 , careful risk assessment of @entity439 related mortality against the risks associated with examinations and interventions is required. METHODS: The literature was reviewed for imaging modalities for EVAR follow up and their advantages and disadvantages. The current evidence and guideline recommendations regarding follow up and re-intervention after EVAR were assessed in relation to the presented case. RESULTS: To detect sac expansion after EVAR, repeated examinations with the same imaging modality are needed. Verified expansion must be above the inter-observer variation of the method used. Although duplex ultrasound is an excellent modality for EVAR follow up, the finding of a significant expansion on duplex requires further examination, primarily with computed tomography angiography to assess sealing, stent graft integrity, and presence of endoleak. A frail @entity1 should be assessed thoroughly before any kind of surgical intervention, the extent of which is related to the identified or suspected cause of expansion. CONCLUSION: Failure to totally exclude the @entity439 from continuing circulation, pressure and endoleak remains a potential shortcoming of EVAR. Significant sac expansion is an indication of EVAR failure. Decisions regarding further examinations or intervention are guided by the stability of the initial EVAR performed, the cause and extent of expansion, and the @entity1 's comorbidities.
