Influence of Home Location on Follow-Up Compliance after Endovascular Treatment for Abdominal Aortic Aneurysm

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

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/1.73m2 (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 prior endograft was associated with significantly worse survival after EVAR (hazard ratio, 3.11; 95% CI, 1.20-8.04).

CONCLUSIONS

Although most patients with rAAAs attend their 1-month postoperative visit, the majority are subsequently lost to follow-up. Geographic proximity to the hospital and higher baseline medical engagement, as indicated by prior endograft and chronic kidney disease, appeared to be protective against such loss. Targeted counseling and engagement at the 1-month postoperative visit, particularly in patients with less comorbid conditions, may enhance retention to long-term follow-up.

Social Determinants of Health Factors and Loss-To-Follow-Up in the Field of Vascular Surgery

BACKGROUND

It is estimated that 22-57% of vascular patients are lost to follow-up (LTF) which is of concern as the Society of Vascular Surgery recommends annual patient follow-up. The purpose of this report was to identify social determinants of health factors (SDoH) and their relationship to LTF in vascular patients.

METHODS

The methods employed were a systematic literature review of 29 empirical articles and a retrospective quality improvement report with 27 endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR) patients at the University of Chicago.

RESULTS

The systematic literature review resulted in 2,931 articles which were reduced to 29 articles meeting the inclusion criteria. Demographic variables were more frequently cited than SDoH factors, but the most common were smoking, transportation, and socioeconomic status/insurance. Additionally, 176 EVAR and TEVAR patients were called resulting in 27 patients who completed a SDoH questionnaire. Twenty-six percent indicated they had missed at least 1 appointment with the top reasons being work or family responsibilities. Due to limited patient size no statistical analyses were performed, but frequencies of responses to SDoH questions were reported to augment the existing limited literature and guide future research into variables such as one's ability to pay for basics like food or mortgage.

CONCLUSIONS

SDoH factors are important yet understudied aspects of endovascular repairs that require more research to understand their impact on vascular surgery follow-up rates and outcomes. Additional research is needed as lack of consideration of such factors may impact the generalizability of existing research and such knowledge may help in informing clinician treatment plans.