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Surgical Decision M...
Surgical Decision Making in Uncomplicated Type B Aortic Dissection : A Survey of Australian/New Zealand and European Surgeons
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- Munshi, Bijit (author)
- QEII Med Ctr, Harry Perkins Inst Med Res, Vasc Engn Lab, Nedlands, WA, Australia.;Univ Western Australia, Ctr Med Res, Perth, WA, Australia.;Univ Western Australia, Fac Hlth & Med Sci, Perth, WA, Australia.;Fiona Stanley Hosp, Dept Vasc Surg, Perth, WA, Australia.
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- Doyle, Barry J. (author)
- QEII Med Ctr, Harry Perkins Inst Med Res, Vasc Engn Lab, Nedlands, WA, Australia.;Univ Western Australia, Ctr Med Res, Perth, WA, Australia.;Univ Western Australia, Sch Engn, Perth, WA, Australia.;Australian Res Council, Ctr Personalised Therapeut Technol, Canberra, ACT, Australia.;Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland.
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- Ritter, Jens C. (author)
- Fiona Stanley Hosp, Dept Vasc Surg, Perth, WA, Australia.
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- Jansen, Shirley (author)
- Univ Western Australia, Ctr Med Res, Perth, WA, Australia.;Univ Western Australia, Fac Hlth & Med Sci, Perth, WA, Australia.;Sir Charles Gairdner Hosp, Dept Vasc & Endovasc Surg, Perth, WA, Australia.;Curtin Univ, Curtin Med Sch, Perth, WA, Australia.;QEII Med Ctr, Heart & Vasc Res Inst, Harry Perkins Inst Med Res, Nedlands, WA, Australia.
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- Parker, Louis P. (author)
- QEII Med Ctr, Harry Perkins Inst Med Res, Vasc Engn Lab, Nedlands, WA, Australia.;Univ Western Australia, Ctr Med Res, Perth, WA, Australia.;Univ Western Australia, Sch Engn, Perth, WA, Australia.
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- Riambau, Vincent (author)
- Univ Barcelona, Hosp Clin, Cardiovasc Inst, Vasc Surg Div, Barcelona, Spain.
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- Bicknell, Colin (author)
- Imperial Coll Healthcare NHS Trust, Imperial Vasc Unit, London, England.;Imperial Coll, Fac Med, London, England.
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- Norman, Paul E. (author)
- QEII Med Ctr, Harry Perkins Inst Med Res, Vasc Engn Lab, Nedlands, WA, Australia.;Univ Western Australia, Ctr Med Res, Perth, WA, Australia.;Univ Western Australia, Fac Hlth & Med Sci, Perth, WA, Australia.;Fiona Stanley Hosp, Dept Vasc Surg, Perth, WA, Australia.
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- Wanhainen, Anders (author)
- Uppsala universitet,Kärlkirurgi
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QEII Med Ctr, Harry Perkins Inst Med Res, Vasc Engn Lab, Nedlands, WA, Australia;Univ Western Australia, Ctr Med Res, Perth, WA, Australia.;Univ Western Australia, Fac Hlth & Med Sci, Perth, WA, Australia.;Fiona Stanley Hosp, Dept Vasc Surg, Perth, WA, Australia. QEII Med Ctr, Harry Perkins Inst Med Res, Vasc Engn Lab, Nedlands, WA, Australia.;Univ Western Australia, Ctr Med Res, Perth, WA, Australia.;Univ Western Australia, Sch Engn, Perth, WA, Australia.;Australian Res Council, Ctr Personalised Therapeut Technol, Canberra, ACT, Australia.;Univ Edinburgh, BHF Ctr Cardiovasc Sci, Edinburgh, Midlothian, Scotland. (creator_code:org_t)
- W B SAUNDERS CO LTD, 2020
- 2020
- English.
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In: European Journal of Vascular and Endovascular Surgery. - : W B SAUNDERS CO LTD. - 1078-5884 .- 1532-2165. ; 60:2, s. 194-200
- Related links:
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http://www.ejves.com...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Subject headings
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- Objective: There is controversy about the role of pre-emptive thoracic endovascular aortic repair (TEVAR) in uncomplicated type B aortic dissection (TBAD). The aim was to understand expert opinions and the factors influencing decision making. Methods: In 2018, surgeons from Australia/New Zealand (ANZ) and Europe (EUR) were contacted to participate in an online survey which comprised questions about preferences for pre-emptive TEVAR, followed by five case scenarios, and two ranking questions for anatomical and technical risk factors respectively. Case 1 was designed to favour TEVAR in a hypertensive patient with partial false lumen thrombosis and large diameter (aortic >= 40 mm, false lumen >= 22 mm). Case 2 had no risk factors mandating TEVAR, according to current evidence. Cases 3, 4, and 5 were designed to test one risk factor respectively, large entry tear on the inner aortic curvature (>= 10 mm), partial false lumen thrombosis, and large diameter alone. Results: There were 75 responses, 42 from EUR and 33 from ANZ. Almost half of surgeons (49.3%) endorsed preemptive TEVAR with 82.3% preferring to perform TEVAR in the subacute phase. In Case 1 and 5, 58.3% and 52.8% of surgeons respectively chose TEVAR, the highest rates obtained in the survey. Cases 1 and 5 included large diameters >= 40 mm, which were ranked the highest in importance when surgeons considered anatomical risk factors. Surgeons who recommend pre-emptive TEVAR were more likely to choose TEVAR in both Case 1 (83.3% vs. 33.3%, p < .001, 95% CI 27.6%-65.8%) and Case 5 (69.4% vs. 38.2%, p = .008, 95% CI 8.2%-50.0%). Conclusion: In this survey about uncomplicated TBAD, about half of surgeons recommended pre-emptive TEVAR in selected cases. The surgeon's predisposition towards intervention and large diameters appear to be the most influential factors in decision making. These findings underline the uncertainty in today's practice and emphasise the need for better predictive tools.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
Keyword
- Dissecting aneurysm
- Endovascular procedures
- Risk
- Surveys and questionnaires
Publication and Content Type
- ref (subject category)
- art (subject category)
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