The sac evolution imaging follow-up after endovascular aortic repair: an international expert opinion-based Delphi consensus study

objective: management of follow-up protocols after endovascular aortic repair (EVAR) varies significantly between centers and is not standardized according to sac regression. by designing an international expert-based delphi consensus, the study aimed to create recommendations on follow-up after EVAR according to sac evolution. methods: eight facilitators created appropriate statements regarding the study topic that were voted, using a 4-point Likert scale, by a selected panel of international experts using a three-round modified delphi consensus process. based on the experts' responses, only those statements reaching a grade a (full agreement >= 75%) or B (overall agreement >= 80% and full disagreement <5%) were included in the final document. results: one-hundred and seventy-four participants were included in the final analysis, and each voted the initial 29 statements related to the definition of sac regression (Q1-Q9), EVAR follow-up (Q10-Q14), and the assessment and role of sac regression during follow-up (Q15-Q29). at the end of the process, 2 statements (6.9%) were rejected, 9 statements (31%) received a grade B consensus strength, and 18 (62.1%) reached a grade a consensus strength. Of 27 final statements, 15 (55.6%) were classified as grade I, whereas 12 (44.4%) were classified as grade II. experts agreed that sac regression should be considered an important indicator of EVAR success and always be assessed during follow-up after EVAR. conclusions: based on the elevated strength and high consistency of this international expert-based Delphi consensus, most of the statements might guide the current clinical management of follow-up after EVAR according to the sac regression. future studies are needed to clarify debated issues.