# Surveillance priorities and outcomes for Veterans treated with endovascular abdominal aortic aneurysm repair

> **NIH VA I01** · WHITE RIVER JUNCTION VA MEDICAL CENTER · 2022 · —

## Abstract

Background: More than 8,000 Veterans undergo abdominal aortic aneurysm (AAA) repair each year. Nearly
70% are treated with endovascular abdominal aortic aneurysm repair (EVAR), where a covered stent is used
to reinforce the weakened aorta. Most national guidelines and regulatory directives mandate annual life-long
surveillance imaging after EVAR, typically provided via a once-yearly contrast-enhanced CT scan. Surveillance
imaging evaluates for blood flowing around the stent into the aorta, called an “endoleak”. While most
endoleaks are harmless, 1-3% are high-pressure “Type I” endoleaks, which lead to rupture and require repair.
However, a point may be reached where continued annual surveillance imaging may not be the best choice for
elderly Veterans after EVAR. Imaging-associated risks include acute kidney injury from contrast dye used
during the CT scan (3-10%), the identification of harmless endoleaks which require no treatment (10-20%), and
incidental findings such as lung or kidney nodules which trigger further invasive testing or treatment (10-15%).
Our scientific rationale in this project centers on better understanding a key gap in knowledge: the tradeoffs
between imaging-associated risks and the chance of identifying a dangerous form of endoleak (1-3%) can be
difficult, especially for aging Veterans with multiple co-morbidities.
Significance: This evidence gap surrounding when to stop surveillance is especially important for Veterans,
who are more frail, elderly, and rural than non-Veteran EVAR populations. We estimate that more than 10,000
Veterans are currently alive with an EVAR in place. This suggests that more than 10,000 scans will be
performed each year based on our preliminary cohort assembly, and more than 500 Veterans will have
complications such as nephrotoxicity. Because it affects a chronic condition among our oldest Veterans, our
study is aligned with the HRD&D Topic Category “Management of Chronic Conditions” and the HSR&D
Specific Priority Area “Long-term Care and Aging”.
Innovation and Impact: There is an absence of guidelines to help Veterans and their clinicians decide when
surveillance imaging should occur, and when its utility may be limited. Developing and disseminating this
evidence would bring an innovative approach towards limiting unnecessary testing and harms among elderly
Veterans.
Specific Aims: We propose a mixed-methods study with two Specific Aims. Aim 1 will qualitatively assess
Veteran, family, and health care team members’ attitudes and beliefs surrounding surveillance imaging after
EVAR. Aim 2 will quantitatively characterize observational data sources to understand surveillance imaging
outcomes after EVAR. Our Dissemination Plan will integrate these findings to create evidence for when
surveillance imaging should continue, and when it may have limited utility. We hypothesize that imaging
associated risks may outweigh the benefits of ongoing surveillance in older Veterans with significant
comorbidities...

## Key facts

- **NIH application ID:** 10421569
- **Project number:** 1I01HX003343-01A2
- **Recipient organization:** WHITE RIVER JUNCTION VA MEDICAL CENTER
- **Principal Investigator:** Philip P Goodney
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2022-08-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10421569

## Citation

> US National Institutes of Health, RePORTER application 10421569, Surveillance priorities and outcomes for Veterans treated with endovascular abdominal aortic aneurysm repair (1I01HX003343-01A2). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10421569. Licensed CC0.

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