Objective: To determine if patient adherence to follow-up and patient outcomes after endovascular aneurysm repair (EVAR) are impacted by the distance a patient lives from a tertiary care treatment center. Methods: A retrospective review of 136 consecutive patients undergoing EVAR at the New Mexico VA Medical Center over a seven year period was conducted. Follow-up occurred with clinic visits and computed tomography scans at one month post-discharge, every six months for two years, and then yearly. Patients were stratified as living within a 100 mile radius of the treatment center (Group 1) versus those living outside this radius (Group 2). Patients were defined as having inadequate follow-up if two or greater consecutive appointments were missed. Survival and graft-related complication rates were analyzed for both patient groups. Results: Operative mortality was 0.74% and the overall mean follow-up time was 52.1±25.9 months in 136 patients. Ten patients were not analyzed due to mortality less than one year from the EVAR procedure. Of the 126 patients eligible for the study, 19 (15%) had inadequate follow-up, as defined by missing two or more appointments. Approximately 44% (60/136) of patients lived within a 100 mile radius of the treatment center (Group 1) versus 56% (76/136) of patients living outside this 100 mile radius (Group 2). There was no difference in the adequacy of follow-up in Group 1 versus Group 2 patients (14.5% vs. 13.3%, P=1.0). The incidence of major complication defined as aneurysm rupture or conversion to open repair was not statistically different in Group 1 versus Group 2 patients (5.0% vs. 11.8%, P=0.23). Five patients (3.7%) died due to AAA-related late causes (2 in Group 1 vs. 3 in Group 2). Conclusions: Recent studies have demonstrated higher catastrophic graft complications in patients with inadequate follow-up after EVAR. As many of these procedures are being performed at tertiary referral care centers, many patients are required to travel a long distance for their procedure and follow-up tests. Our study indicates that distance from a tertiary care center is not a limiting factor in patient adherence to follow-up, patient graft-related morbidity or patient survival.
Sarangarm, Dusadee; Mark Langsfeld; and John Marek. "Post-Endovascular Aneurysm Repair Patient Outcomes and Follow-up Are Not Adversely Impacted By Long Travel Distance to Tertiary Vascular Surgery Centers." (2008). http://digitalrepository.unm.edu/ume-research-papers/39