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Bypass or angioplasty for severe limb ischaemia? A Delphi Consensus Study
A W Bradbury1, J Bell, A J Lee
1BASIL Trial Office, Research Institute (Lincoln House), Heartlands Hospital, University of Birmingham, UK.
Summary
Vascular surgeons and interventional radiologists show significant disagreement on managing severe limb ischaemia. This lack of consensus highlights a need for evidence-based guidelines to ensure consistent patient care.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Health Services Research
Background:
- Severe limb ischaemia management involves complex decisions between surgical and endovascular approaches.
- Current treatment preferences vary significantly among specialists, potentially impacting patient outcomes.
Purpose of the Study:
- To assess the level of agreement between vascular surgeons and interventional radiologists on managing severe limb ischaemia.
- To identify areas of consensus and disagreement in treatment preferences.
Main Methods:
- A Delphi consensus study involving 596 hypothetical patient scenarios.
- Twenty vascular surgeons and 17 interventional radiologists participated in two rounds of மதிப்பீடு.
- Treatment preferences for surgery versus angioplasty were scored, with agreement defined by responses falling within a 3-point range.
Main Results:
- Substantial disagreement was observed in 81% of scenarios in round 1 and 67% in round 2.
- Disagreement was consistently higher among surgeons than radiologists.
- Surgeons showed less convergence in their treatment preferences between study rounds.
Conclusions:
- Significant disagreement exists between and among vascular surgeons and interventional radiologists regarding the management of severe limb ischaemia.
- The lack of consensus is attributed to the absence of a robust evidence base.
- This variation in treatment recommendations has implications for clinical practice and health resource allocation.