An international, expert-based, Delphi consensus document on controversial issues in the management of abdominal aortic aneurysms

IF 3.9 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2025-02-01 DOI:10.1016/j.jvs.2024.08.012

Kosmas I. Paraskevas MD , Marc L. Schermerhorn MD, FACS , Stephan Haulon MD, PhD , Adam W. Beck MD, FACS , Hence J.M. Verhagen MD, PhD , Jason T. Lee MD, FACS , Eric L.G. Verhoeven MD, PhD , Jan D. Blankensteijn MD, PhD , Tilo Kölbel MD, PhD , Sean P. Lyden MD, FACS , Daniel G. Clair MD, FACS , Gianluca Faggioli MD, PhD , Theodosios Bisdas MD, PhD , Mario D'Oria MD, PhD , Kevin Mani MD, PhD , Karl Sörelius MD, PhD , Enrico Gallitto MD, PhD , Jose Fernandes e Fernandes MD, PhD, FACS, FRCS, FESC, FEBVS , Athanasios Katsargyris MD, PhD , Sandro Lepidi MD, PhD , Ronald L. Dalman MD, FACS

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引用次数: 0

Abstract

Objective

As a result of conflicting, inadequate or controversial data in the literature, several issues concerning the management of patients with abdominal aortic aneurysms (AAAs) remain unanswered. The aim of this international, expert-based Delphi consensus document was to provide some guidance for clinicians on these controversial topics.

Methods

A three-round Delphi consensus document was produced with 44 experts on 6 prespecified topics regarding the management of AAAs. All answers were provided anonymously. The response rate for each round was 100%.

Results

Most participants (42 of 44 [95.4%]) agreed that a minimum case volume per year is essential (or probably essential) for a center to offer open or endovascular AAA repair (EVAR). Furthermore, 33 of 44 (75.0%) believed that AAA screening programs are (probably) still clinically effective and cost effective. Additionally, most panelists (36 of 44 [81.9%]) voted that surveillance after EVAR should be (or should probably be) lifelong. Finally, 35 of 44 participants (79.7%) thought that women smokers should (or should probably/possibly) be considered for screening at 65 years of age, similar to men. No consensus was achieved regarding lowering the threshold for AAA repair and the need for deep venous thrombosis prophylaxis in patients undergoing EVAR.

Conclusions

This expert-based Delphi consensus document provides guidance for clinicians regarding specific unresolved issues. Consensus could not be achieved on some topics, highlighting the need for further research in those areas.

查看原文本刊更多论文

关于腹主动脉瘤管理争议问题的国际专家德尔菲共识文件。

目的：由于文献中的数据相互矛盾、不充分或存在争议，有关腹主动脉瘤（AAA）患者管理的几个问题仍未得到解答。这份基于国际专家的德尔菲共识文件旨在就这些有争议的问题为临床医生提供一些指导：方法：44 位专家就有关 AAA 管理的 6 个预先指定的主题编写了一份三轮德尔菲共识文件。所有答案均以匿名方式提供。每轮的回复率均为 100%：大多数参与者（44 位中的 42 位；95.4%）同意，对于提供开放式/血管内 AAA 修补术 (EVAR) 的中心而言，最低病例量/年是必要条件（或可能是必要条件）。此外，44 位专家中有 33 位（75.0%）认为 AAA 筛查项目（可能）仍然具有临床效果和成本效益。此外，大多数专家组成员（44 人中有 36 人，占 81.9%）认为 EVAR 后的监测应该（或可能应该）是终身性的。最后，44 位参与者中有 35 位（79.7%）认为女性吸烟者应该（或可能/应该）与男性吸烟者一样在 65 岁时接受筛查。对于降低AAA修复的门槛以及接受EVAR手术的患者是否需要预防深静脉血栓形成，与会者未达成共识：这份以专家为基础的德尔菲共识文件为临床医生提供了有关具体未决问题的指导。在某些主题上未能达成共识，这说明需要在这些领域开展进一步研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.