Proximity and prior medical engagement influence follow-up after ruptured abdominal aortic aneurysm

作     者：Ghosh, Rahul Bahnmiller, Jacob Warren, Andrew Quiroga, Elina Singh, Niten Starnes, Benjamin W. Zettervall, Sara L. Dansey, Kirsten D. 

作者机构：Univ Washington Div Vasc Surg 1959 NE Pacific StBox 358811 Seattle WA 98195 USA Texas A&M Coll Med MD PhD Program College Stn TX USA Pacific Northwest Univ Hlth Sci Coll Osteopath Med Yakima WA USA 

出 版 物：《JOURNAL OF VASCULAR SURGERY》 

年 卷 期：2025年第81卷第5期

页      面：1074-1082页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：Endovascular aneurysm repair Imaging surveillance Loss to follow-up Open surgical repair Ruptured abdominal aortic aneurysm 

摘      要：Objective: Post-repair surveillance of ruptured abdominal aortic aneurysm (rAAA) is critical for detecting potential complications. Substantial loss to follow-up has been reported in populations undergoing elective endovascular aortic repair (EVAR);however, there is limited data on follow-up rate among patients presenting with rupture. Thus, we investigated follow-up trends and factors influencing retention at a major academic referral center with a wide service area. Methods: We included patients with rAAAs from 2002 through 2023 in this retrospective study. Loss to follow-up was defined as absence of vascular surgeon evaluation for 2 years (EVAR) or 5 years (open repair) prior to death or present day. Multivariate regression and survival models assessed the influence of potential factors on follow-up and survival outcomes. Results: Of 455 patients who presented with rAAAs, 60% who underwent EVAR and 39% who underwent open repair were lost to follow-up. Twenty percent of patients who underwent EVAR were lost after initial admission, and 40% of patients were lost after the 1-month postoperative follow-up visit. There were no significant differences in baseline demographics. Patients lost to follow-up less commonly had stage 4 chronic kidney disease (7.2% vs 24.3%;P = .02) and prior EVAR (10.0% vs 29.2%;P = .01) at time of rupture. Secondary interventions were less common in patients lost to follow-up (14.5% vs 39.0%;P = .01). In multivariate analysis of patients who underwent an EVAR, residing more than 10 miles from hospital was associated with loss to follow-up (odds ratio [OR], 4.93;95% confidence interval [CI], 1.14-21.29). Prior endograft at time of rupture (OR, 0.24;95% CI, 0.06-0.89), and estimated glomular filtration rate 30 mL/min/1.73m(2) (OR, 0.23;95% CI, 0.06-0.93) were associated with complete follow-up in patients who underwent EVAR. Patients who were lost to follow-up trended towards worse survival (hazard ratio, 2.04;95% CI, 0.67-6.26), whereas prio