Current state of the art on implantable sensors for continuous post-EVAR surveillance of abdominal aortic aneurysms: A comprehensive review

Post-endovascular aneurysm repair (EVAR) surveillance currently relies on routine imaging techniques such as computed tomography angiography and magnetic resonance angiography, which expose patients to radiation, nephrotoxic contrast agents, and place logistical burdens on healthcare systems. This review critically examines the potential of implantable sensors, particularly pressure-monitoring systems, to provide continuous, minimally invasive post-EVAR surveillance. We present an overview of the biological and biomechanical rationale for monitoring aneurysm sac pressurization, analyze existing sensor technologies including EndoSure® and ImPressure®, and discuss technical challenges such as wireless telemetry, biocompatibility, signal attenuation, and power management. Regulatory milestones and alignment with ESVS and SVS surveillance guidelines are reviewed, along with the current evidence gap between pressure trends and clinical outcomes such as reintervention or rupture. While technical feasibility has been demonstrated in controlled settings, no studies to date have shown that pressure monitoring improves long-term outcomes or guides decision-making independently of imaging. The limitations of pressure-based monitoring are discussed alongside emerging sensor designs that integrate pressure, morphological, and biochemical sensing. This review concludes that implantable pressure sensors remain investigational tools whose clinical adoption will depend on future trials demonstrating diagnostic accuracy, patient acceptability, cost-effectiveness, and outcome benefit.