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

Area of Science:

• Vascular Surgery
• Endovascular Interventions
• Aortic Aneurysm Management

Background:

• Complex abdominal aortic aneurysms (AAA) present a management challenge due to patient comorbidities.
• Limited consensus exists on optimal treatment strategies for AAA.
• Advances in endovascular technology offer multiple device options for AAA repair.

Purpose of the Study:

• To quantify management variability for complex AAA among vascular specialists.
• To compare treatment preferences across different countries.

Main Methods:

• An online survey was distributed to vascular surgery societies in Great Britain/Ireland, Canada, and Australia/New Zealand.
• A clinical vignette of a juxtarenal AAA in a patient with comorbidities was presented.
• Survey questions focused on aneurysm management decisions, including imaging.

Main Results:

• 238 responses were analyzed, with significant international variations in treatment approach.
• Australia/New Zealand specialists were most likely to recommend endovascular repair.
• Canada favored open surgery, while the UK/Ireland leaned towards surveillance.

Conclusions:

• Substantial international variation exists in managing juxtarenal AAA.
• Treatment preferences differ significantly between vascular specialists in different countries.
• Lack of long-term evidence and international consensus contributes to management variability.