National Audit of Endovascular Infra-renal AAA Surveillance


VERN would like to thank Mr Tristan Lane, Mandy Burrows, Dr Mark Theodoreson, Mr Shiva Dindyal, Mr Thomas Hardy, Mr Sandip Nandhra, Mr Jakub Kacynski, Dr Joe Filby, Dr Joshua Brown, Miss Kathryn Boyce, Mr Ayoola Awopetu, Mr Nadeem Mughal, Maira Hameed and Mr Graeme Ambler for their contribution of data to this study.

Background:

Endovascular abdominal aortic aneurysm repair (EVAR) within the United Kingdom has a variable, peri-operative mortality. Standard perioperative and postoperative strategies differ between vascular units and may impact on outcomes. The aim of this audit is to highlight differences in practise.

Methods:

Utilising the Vascular and Endovascular Research Network, participating centres were invited to complete an audit questionnaire of standard EVAR practises within their vascular unit. The results of this were collated and quantitavely analysed.

Results:

A total of 15 vascular units submitted data all of which undertook standard infra-renal EVAR. Only two units undertook day case EVAR. The majority discuss all patients (100%) at a weekly multi-disciplinary meeting prior to EVAR although 3 do not. All but three centres prefer a general anaesthetic (3 utilise a spinal/epidural first approach) with most centres utilising a completion angiogram (single or dual plane) although 2 do not. Seven units do not perform routine postoperative inpatient imaging. From those that do, 3 utilise duplex, 1 Computed tomography and 2 plain X ray. The majority of centres undertake lifelong stent graft surveillance (frequency and timing of surveillance vary greatly) while 4 centres follow up to 5 or 10 years respectively. Seven centres do not routinely have a vascular radiologist with EVAR experience on call.

Conclusions:

Variation exists in standard EVAR practises between vascular units in the UK. By standardising practise between units it may be possible to further reduce post EVAR morbidity and mortality nationally.

University Hospitals of Leicester

London North West Hospitals NHS Trust

Norfolk and Norwich University Hospital

University Hospital Coventry and Warwick

Imperial Healthcare NHS Trust

Derriford Hospital

North-East Central Vascular Unit

Forth Valley Royal Hospital

Royal Gwent Hospital

University Hospital of Wales

Ipswich Hospital

Colchester General Hospital

John Radcliffe Hospital

Wrexham Maelor Hospital