Safety and Validity of the Proposed European Society for Vascular Surgery Infrarenal Endovascular Aneurysm Repair Surveillance Protocol: A Single Centre Evaluation

Background Simplifying a postoperative surveillance protocol for endovascular aneurysm repair (EVAR) requires quality control comparing computerized tomography (CT) and ultrasound (US) results of abdominal aortic aneurysm (AAA) diameter measurements and endoleaks. Purpose To test if US is comparable to CT, then assess a simplified follow-up with our conventional surveillance to assess patient safety. Material and Methods During 2001-2006, data on 56 patients treated with Talent stent graft were prospectively registered. Median follow-up was 41.5 months (range, 2-94 months), with CT, US, and plain film abdomen X-rays (PFA) at 1, 6, and 12 months, then yearly. Bland-Altman plot was used to assess the agreement between CT and US measuring the AAA diameters and mixed model by the time effect to assess the difference in diameter over time. Sensitivity and specificity for detection of endoleaks by US, with CT as ‘gold standard’ were calculated. A simplified surveillance protocol with US/PFA at 6 and 8 weeks, CT/US/PFA at 1 year, and yearly US/PFA thereafter, was evaluated. CT was carried out when poor visibility, endoleak detected, AAA diameter increase (≥5 mm) on US or migration (≥10 mm) on PFA. This regime was compared with our conventional follow-up protocol. Results Diameter measurements on US appear comparable to CT with 91% specificity and 85% sensitivity for endoleaks detected by US. Using the simplified surveillance protocol no endoleaks, migrations, or endotension requiring treatment were overlooked. The simplified protocol generated 53 selective CT scans, avoiding approximately 144 CT scans. If further simplified by omitting the 1-year CT scan, one type II endoleak would be missed with a 1-year delay, eliminating a further 45 CT scans. Conclusion US appears comparable to CT in the follow-up of Talent stent grafts in our institution. The proposed simplified surveillance protocol seems safe and can lead to a significant reduction in the number of CT scans.

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Early and Intermediate Outcome of Emergency Endovascular Aneurysm Repair of Ruptured Infrarenal Aortic Aneurysm: A Single-Centre Experience of 90 Consecutive Patients

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2008.12.015 ◽

2009 ◽

Vol 37 (4) ◽

pp. 413-419 ◽

Cited By ~ 16

Author(s):

J. Holst ◽

T. Resch ◽

K. Ivancev ◽

K. Björses ◽

N. Dias ◽

...

Keyword(s):

Aortic Aneurysm ◽

Endovascular Aneurysm Repair ◽

Single Centre ◽

Infrarenal Aortic Aneurysm ◽

Intermediate Outcome ◽

Single Centre Experience ◽

Aneurysm Repair

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Outcomes after endovascular aneurysm repair conversion and primary aortic repair for urgent and emergency indications in the Society for Vascular Surgery Vascular Quality Initiative

Journal of Vascular Surgery ◽

10.1016/j.jvs.2016.02.028 ◽

2016 ◽

Vol 64 (2) ◽

pp. 338-347 ◽

Cited By ~ 10

Author(s):

Salvatore T. Scali ◽

Sara J. Runge ◽

Robert J. Feezor ◽

Kristina A. Giles ◽

Javairiah Fatima ◽

...

Keyword(s):

Vascular Surgery ◽

Endovascular Aneurysm Repair ◽

Aortic Repair ◽

Aneurysm Repair

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Future of Vascular Surgical Training: The Trainees' Views

Annals of The Royal College of Surgeons of England ◽

10.1308/003588408x261690 ◽

2008 ◽

Vol 90 (2) ◽

pp. 96-99 ◽

Cited By ~ 7

Author(s):

Toby Richards ◽

Keith Jones

Keyword(s):

Vascular Surgery ◽

Surgical Training ◽

General Surgery ◽

Endovascular Aneurysm Repair ◽

Endovascular Techniques ◽

European Working ◽

The Uk ◽

Aneurysm Repair ◽

Working Time Directive ◽

Future Work

INTRODUCTION In the UK, surgical training includes all aspects of general surgery. Vascular surgery is not an independent specialty. We wished to assess the views of vascular trainees in UK on the future of vascular surgery and training. MATERIALS AND METHODS Trainees were surveyed in 2003, 2004 (after introduction of the European Working Time Directive) and 2005, concentrating on four areas – future practise of vascular surgery, role of endovascular training, vascular specialisation and future training. RESULTS The majority of trainees want to practise vascular surgery alone. In 2003, 80% thought training should include endovascular techniques. By 2005, all trainees regarded training as mandatory as endovascular techniques would represent a significant part of their future work. Opinion changed on training; from 4 years general then 2 years vascular surgery (qualification in general surgery) to 2 years general and 4 years vascular surgery (specialist qualification in vascular surgery; P < 0.0001). Opinion also changed, that vascular surgery should spilt from general surgery to form its own speciality (P < 0.0007). CONCLUSIONS Trainees now regard training in endovascular techniques and endovascular aneurysm repair as mandatory. The majority wish to specialise from general surgery and achieve a separate qualification in vascular surgery.

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