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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2018 Jan 23

DOI: 10.23736/S0021-9509.18.10129-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Is management of complex abdominal aortic aneurysms consistent? A questionnaire based survey

Eleanor ATKINS 1, Nadeem A. MUGHAL 2, Graeme K. AMBLER 3, Ranjeet NARLAWAR 4, Francesco TORELLA 5, George A. ANTONIOU 1

1 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS, Trust, Manchester, UK; 2 Department of Vascular Surgery, Norfolk and Norwich University Hospitals, Norwich, UK; 3 Division of Population Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, UK; 4 Department of Radiology, The Royal Oldham Hospital, Pennine Acute Hospitals NHS, Trust, Manchester, UK; 5 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital, Liverpool, UK


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BACKGROUND: Complex abdominal aortic aneurysm (AAA) is a relatively common presentation to the vascular specialist. Despite this there is little consensus on how to manage the often co-morbid group of patients. Recent advances in endovascular technology have led to the availability of multiple devices, many of which could be used to treat the same aneurysm. The aim of this study was to quantify this potential variability across vascular specialists from multiple countries.
METHODS: An online survey was emailed to members of the Vascular Society for Great Britain and Ireland (VSGBI), the Canadian Society for Vascular Surgery (CSVS) and the Australian and New Zealand Society for Vascular Surgery (ANZSVS). The survey presented a vignette of a 63-year-old woman with significant respiratory co-morbidity and a 54 mm juxtarenal AAA (7 mm neck). There were no other adverse morphological features for endovascular repair. The survey included images and questions related to management of the aneurysm.
RESULTS: 238 responses were received; 61 from ANZSVS, 65 from CSVS and 112 from VSGBI. VSGBI specialists were significantly more likely to continue surveillance than both ANZSVS (odds ratio (OR) 3.41, 95% confidence interval (CI) 1.61-7.65; p<0.001) and CSVS counterparts (OR 2.61, 95% CI 1.29-5.47; p<0.01). ANZSVS specialists were significantly more likely to perform an endovascular repair than those from CSVS (OR 3.28, 95% CI 1.50-7.40; p<0.01) and VSGBI (OR 3.65, 95% CI 1.81-7.59; p<0.001). CSVS specialists were significantly more likely to manage the aneurysm with open surgery than colleagues from the VSGBI (OR 6.57, 95% CI 2.58-18.46; p<0.001) and ANZSVS (OR 7.18, 95% CI 2.22-30.79; p<0.001).
CONCLUSIONS: Significant variation in the management of a juxtarenal AAA between countries was observed. The same patient would be more likely to have an endovascular repair in Australia and New Zealand, open surgery in Canada and continuing surveillance in the UK and Ireland. This variation reflects the lack of long-term evidence and international consensus on the optimal management of complex AAA.


KEY WORDS: Abdominal aortic aneurysm - Aneurysm neck - Endovascular aneurysm repair - Endograft - Computed tomographic angiography

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Publication History

Article first published online: January 23, 2018
Manuscript accepted: January 23, 2018
Manuscript revised: November 17, 2017
Manuscript received: July 25, 2017

Per citare questo articolo

Atkins E, Mughal NA, Ambler GK, Narlawar R, Torella F, Antoniou GA. Is management of complex abdominal aortic aneurysms consistent? A questionnaire based survey. J Cardiovasc Surg 2018 Jan 23. DOI: 10.23736/S0021-9509.18.10129-7

Corresponding author e-mail

antoniou.ga@hotmail.com