Proximity and Prior Medical Engagement Influence Follow-Up After Ruptured Abdominal Aortic Aneurysm.

Abstract

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 rAAA from 2002-2023 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 rAAA, 60% who underwent EVAR and 39% who underwent open repair were lost to follow-up. 20% of patients who underwent EVAR were lost after initial admission and 40% of patients were lost after the 1-month post-operative follow-up visit. There were no significant differences in baseline demographics. Patients lost to follow-up less commonly had Stage 4 CKD (7.2% vs. 24.3%, p = 0.02) and prior EVAR (10.0% vs 29.2%, p=0.01) at time of rupture. Secondary interventions were less common in patients lost to follow-up (14.5% vs 39.0%, p=0.01). In multivariate analysis of patients who underwent an EVAR, residing more than 10 miles from hospital was associated with loss to follow-up (OR:4.93 [1.14-21.29]). Prior endograft at time of rupture (OR:0.24 [0.06-0.89]), and eGFR < 30 (OR:0.23 [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 (HR 2.04 [0.67-6.26]), while prior endograft was associated with significantly worse survival after EVAR (HR 3.11 [1.20 - 8.04]).

Conclusions: Although most patients with rAAA attend their 1-month post-operative 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 post-operative visit, particularly in patients with less comorbid conditions, may enhance retention to long-term follow-up.