IP05 - Sac Shrinkage Without Endoleak at One Year After EVAR Pragmatically Identifies a Low-Risk Group Eligible for Reduced Surveillance

Wednesday, June 10, 2026

1:56 PM - 2:01 PM ET

Location: Hynes CC, Third Level, Room 306

Submitting & Presenting Author(s)

Davide Esposito, MD (he/him/his)

MD, Vascular Surgeon
Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
Genoa, Liguria, Italy

Co-Author(s)

MB

Martina Bastianon, MD

Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
Giulio Accarino, MD, PhD (he/him/his)

Vascular and Endovascular Surgery Unit, San Giovanni di Dio e Ruggi D'Aragona Hospital, University of Salerno, Salerno, Italy
Cava De’ Tirreni, Campania, Italy
SP

Sofia Pierozzi

Unit of Vascular Surgery, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
CM

Caterina Melani

Clinic of Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
FG

Fabio Grimaldi

Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
EB

Enrica Bosisio

Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
GB

Giuseppe Baldino

Clinic of Vascular and Endovascular Surgery, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
RP

Raffaele Pulli

FULL PROFESSOR OF VASCULAR SURGERY
University of Florence
Florence

Senior Author(s)

GP

Giovanni Pratesi

Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy

Objectives: This study aimed to explore a simple risk stratification approach to identify patients who may safely undergo less intensive surveillance following standard endovascular aneurysm repair (EVAR).

Methods: This multicenter, retrospective, observational study included all consecutive patients treated with standard EVAR for infrarenal abdominal aortic aneurysm (AAA) between January 2014 and December 2018, with documented adherence to at least 5 years of follow-up. Patients were classified as low risk if, at the one-year follow-up, they demonstrated aneurysm sac shrinkage (defined as a decrease of ≥5 mm in the maximum aneurysm sac diameter compared with the baseline measurement) and no evidence of endoleak. All remaining patients were classified as high risk. The two groups were compared. Primary endpoints were 5-year reintervention rates and 5-year rupture or infection events. Secondary endpoints included long-term estimates of freedom from reintervention and AAA-related mortality.

Results: The study cohort comprised 489 EVAR patients with complete one-year sac dynamics data and a minimum of 5 years of follow-up. Of these, 199 patients (40.7%) demonstrated sac shrinkage without endoleak at one year and were classified as low risk. During the first 5 years of follow-up, 69 reinterventions and 12 rupture or infection events were recorded. Low-risk patients experienced significantly fewer reinterventions (5.5% vs 20.0%, p<.001) and rupture/infection events (0.5% vs 3.8%, p=.021) compared with high-risk patients.
Over a median follow-up of 61 months (interquartile range 51), Kaplan–Meier analysis demonstrated higher 8-year freedom from reintervention in the low-risk group (86.9% vs 55.1%; log-rank 34.3, p<.001, Figure 1) as well as higher freedom from AAA-related mortality (99.4% vs 95.9%; log-rank 4.3, p=.039, patients at risk >20, standard error < 10%).

Conclusions: In this multicenter cohort with consistent long-term follow-up, a simple risk stratification method based on one-year sac dynamics and endoleak status effectively identified patients at low risk of late EVAR-related complications. This pragmatic approach may support tailored surveillance strategies in selected patients, potentially reducing healthcare costs and patient burden without compromising safety.