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REPAIRS Delphi: A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary
Caitlin S MacLeod1, John Nagy2, Andrew Radley3
1Department of Vascular Surgery, Ninewells Hospital, NHS Tayside, Dundee, UK; Division of Systems Medicine, University of Dundee, Dundee, UK.
Insights
This study established consensus on managing infected arterial pseudoaneurysms from injecting drug use. The preferred initial surgical approach is ligation and debridement without reconstruction, alongside multidisciplinary care.
Area of Science:
- Vascular Surgery
- Infectious Disease Management
- Public Health
Background:
- Infected arterial pseudoaneurysms secondary to injecting drug use pose a significant clinical challenge.
- Optimal management strategies are not well-defined, leading to variability in care.
- There is a need for consensus guidelines to improve patient outcomes.
Purpose of the Study:
- To establish expert consensus on the optimal management of infected arterial pseudoaneurysms in injecting drug users.
- To provide evidence-based recommendations for diagnosis, imaging, and surgical intervention.
- To promote standardized and effective patient care.
Main Methods:
- A three-round modified Delphi survey was conducted among UK and Ireland consultant vascular surgeons.
- Seventy-five vascular surgery units participated, providing consensus practice.
- Consensus was defined as 70% agreement or disagreement on Likert scale-evaluated statements.
Main Results:
- High response rates ensured robust consensus (73/75 units contributed).
- Computed tomography angiography was the preferred pre-operative imaging modality (97% agreement).
- Ligation and debridement without arterial reconstruction was the favored initial surgical approach (89% agreement).
Conclusions:
- This consensus statement offers critical insights into current best practices for managing these complex cases.
- Multidisciplinary management, including substance use services, is essential for holistic patient care.
- The findings provide a foundation for improved clinical guidelines and patient management.
Objective:
Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use.
Methods:
A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement.
Results:
Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computed tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement.
Conclusion:
This comprehensive consensus statement provides a strong insight into the standard of care for these patients.
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