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An international, expert-based, Delphi consensus document on controversial issues in the management of abdominal

Kosmas I Paraskevas1, Marc L Schermerhorn2, Stephan Haulon3

  • 1Department of Vascular Surgery, Red Cross Hospital, Athens, Greece.

Journal of Vascular Surgery
|August 15, 2024
PubMed

Insights

Expert consensus suggests annual case volume is crucial for abdominal aortic aneurysm (AAA) repair centers. AAA screening may remain effective and cost-effective, with lifelong surveillance after endovascular repair (EVAR) recommended.

Area of Science:

  • Vascular Surgery
  • Medical Consensus Building
  • Public Health Screening

Background:

  • Management of abdominal aortic aneurysms (AAAs) presents unresolved clinical questions due to conflicting literature.
  • Existing data on AAA management is inadequate or controversial, necessitating expert guidance.

Purpose of the Study:

  • To provide clinical guidance on controversial topics in abdominal aortic aneurysm (AAA) management.
  • To establish expert consensus on key issues in AAA patient care.

Main Methods:

  • A three-round Delphi consensus process involving 44 international experts.
  • Anonymously addressed 6 prespecified topics on AAA management with 100% response rate per round.

Main Results:

  • 95.4% agreement on essential minimum annual case volume for AAA repair centers (open or EVAR).
  • 75.0% belief in the clinical and cost-effectiveness of AAA screening programs.
  • 81.9% consensus for lifelong surveillance post-EVAR.
  • 79.7% support for considering women smokers for AAA screening at age 65.

Conclusions:

  • This Delphi consensus provides expert guidance on several unresolved AAA management issues.
  • Lack of consensus on specific topics, such as AAA repair thresholds and DVT prophylaxis post-EVAR, indicates areas requiring further research.
Abstract

Keywords:
AAAAbdominal aortic aneurysmDelphiEVAROpen surgical repairPerioperative mortality

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