Is the management of complex abdominal aortic aneurysms consistent across the UK? A questionnaire-based survey

Our objective was to quantify variability across the UK in the management of a complex abdominal aortic aneurysm (AAA).

An online survey was emailed to all members of the Vascular Society for Great Britain and Ireland. The survey presented a vignette of a 63-year-old woman with significant respiratory co-morbidity whose computed tomographic (CT) angiogram demonstrated a 54 mm AAA with a short (7 mm) proximal neck but no other adverse morphological features for a standard or complex endovascular aneurysm repair (EVAR). The survey included images and questions related to AAA management as well as surgeon access to operating facilities. 111 responses were received.

47% of participants indicated a preference for continuing surveillance, 29% for fenestrated EVAR and 7% each for no operative intervention and open surgical repair. The remainder indicated various preferences including standard EVAR (3%), standard EVAR with endoanchors (3%), chimney EVAR (2%), EVAS (endovascular aneurysm sealing) (1%) and chimney EVAS (1%). Of the 47% who wanted to continue surveillance, once their threshold was reached, 73% would manage with a fenestrated EVAR, 17% with open repair and the remainder with standard EVAR with endoanchors (2%), EVAS (2%) or chimney EVAS (2%). 49% of participants carried out endovascular procedures in hybrid theatres, 36% in radiology angiosuites and 15% in standard operating theatres. The location had no significant effect on the consultant choice of treatment method.

The study results support anecdotal variation in practice among vascular specialists. This reflects the lack of solid evidence on the optimal management of complex AAA.