Telemedicine for screening and follow-up of abdominal aortic aneurysm

I read with much interest the report by Rokosh et al.¹ The suggested guidelines were based on the evidence that postoperative surveillance is required to reduce the risk of late rupture and aneurysm-related death after both endovascular abdominal aortic aneurysm repair and open surgical repair. Rokosh et al¹ commented “The development of validated strategies to improve patient compliance with post-EVAR [endovascular abdominal aortic aneurysm repair] surveillance represents a critical need, with recent reports noting ≥50% nonadherence at 5 years.”

Similar attendance problems have been found for patients with small abdominal aortic aneurysms monitored with serial ultrasound examinations.2, 3, 4 These problems have been accentuated during the COVID-19 (coronavirus disease 2019) pandemic period. Selway et al⁵ reported that only 59% of the 200 interviewed patients who had been followed up with serial scans before the pandemic because of a small aneurysm would attend their surveillance scan appointment. Most of those surveyed were more concerned about catching COVID-19 than their aneurysm.

It is possible that the problems of low attendance to postoperative follow-up and screening appointments could persist and increase in the future. Selway et al⁵ have underlined how it will be difficult to return to the attendance rates of the pre–COVID-19 pandemic period. Thus, although it might sound unethical, the critical conditions resulting from the pandemic might provide the stimulus to perfect a new vision of surgery.

Telemedicine offers a variety of horizons, and it could be more applicable, with lower costs, and more easily accepted by patients. A simple application on the cellphone or computer might allow for a sophisticated and accurate ultrasound analysis that could provide all the dimensions of the aneurysm (ie, transverse diameter, difference from the previous examination, elasticity of the aneurysmal wall) and the presence of graft complications. The patients would only apply the ultrasound probe to the navel, and all the information would be sent to the health center. If needed, the patient could be called in for a more detailed study at the clinic. After the COVID-19 pandemic crisis, the improvements in telemedicine will remain and might represent the basis for future patient–physician relationships. The use of telemedicine can facilitate follow-up visits and diffuse screening programs, even for people in distant regions and countries.