Objective: Management of follow-up protocols after endovascular aortic repair (EVAR) varies significantly between centers and is not standardized according to sac regression. By designing an international expert-based Delphi consensus, the study aimed to create recommendations on follow-up after EVAR according to sac evolution. Methods: Eight facilitators created appropriate statements regarding the study topic that were voted, using a 4-point Likert scale, by a selected panel of international experts using a three-round modified Delphi consensus process. Based on the experts' responses, only those statements reaching a grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final document. Results: One-hundred and seventy-four participants were included in the final analysis, and each voted the initial 29 statements related to the definition of sac regression (Q1-Q9), EVAR follow-up (Q10-Q14), and the assessment and role of sac regression during follow-up (Q15-Q29). At the end of the process, 2 statements (6.9%) were rejected, 9 statements (31%) received a grade B consensus strength, and 18 (62.1%) reached a grade A consensus strength. Of 27 final statements, 15 (55.6%) were classified as grade I, whereas 12 (44.4%) were classified as grade II. Experts agreed that sac regression should be considered an important indicator of EVAR success and always be assessed during follow-up after EVAR. Conclusions: Based on the elevated strength and high consistency of this international expert-based Delphi consensus, most of the statements might guide the current clinical management of follow-up after EVAR according to the sac regression. Future studies are needed to clarify debated issues.
The sac evolution imaging follow-up after endovascular aortic repair: An international expert opinion-based Delphi consensus study / Tinelli, G.; D'Oria, M.; Sica, S.; Mani, K.; Rancic, Z.; Resch, T. A.; Beccia, F.; Azizzadeh, A.; Da Volta Ferreira, M. M.; Gargiulo, M.; Lepidi, S.; Tshomba, Y.; Oderich, G. S.; Haulon, S.; Beck, A. W.; Hertault, A.; Savlania, A.; Froio, A.; Giaquinta, A.; Zimmermann, A.; Psyllas, A.; Wanhainen, A.; Marchetti, A. A.; Queiroz, A. B.; Kahlberg, A.; Reyes-Valdivia, A.; Schanzer, A.; Tambyraja, A.; Freyrie, A.; Lorido, A.; Millon, A.; Ippoliti, A.; Abai, B.; Mees, B.; Reutersberg, B.; Maurel, B.; Michel, B.; Wahlgren, C. M.; Cavazzini, C.; Setacci, C.; Lee, C. J.; Ferrer, C.; Bicknell, C.; Raphael, C.; Clair, D.; Dawson, D. L.; Arnaoutakis, D. J.; Bockler, D.; Kotelis, D.; Mujagic, E.; Chisci, E.; Cieri, E.; Gallitto, E.; Marone, E. M.; Ducasse, E.; Verzini, F.; Pecoraro, F.; Serracino-Inglott, F.; Benedetto, F.; Speziale, F.; Stilo, F.; Alvarez-Marcos, F.; Pagliariccio, G.; Piffaretti, G.; Lanza, G.; Philipp, G.; Geenberg, G.; Jung, G.; Melissano, G.; Veraldi, G. F.; Parlani, G.; Faggioli, G.; de Donato, G.; Simonte, G.; Colacchio, G.; De Caridi, G.; Pratesi, G.; Spinella, G.; Torsello, G.; Leong Tan, G. W.; Magee, G. A.; Verhagen, H.; Andrew, H.; Koleilat, I.; Ohman, J. W.; de Vries, J. P. P. M.; Budtz-Lilly, J.; Black, J.; Eldrup-Jorgensen, J.; Hockley, J.; Bath, J.; Sobocinski, J.; van Herwaarden, J. A.; Reinhard, K.; Orion, K. C.; Amankwah, K.; Bertoglio, L.; di Marzo, L.; Garriboli, L.; Rizzo, L.; Hakimi, M.; Sheahan, M.; Khashram, M.; Schermerhorn, M.; Lescan, M.; Conrad, M.; Davies, M. G.; Czerny, M.; Orrico, M.; Eagleton, M. J.; Smeds, M. R.; Taurino, M.; Wohlauer, M.; Sharafuddin, M. J.; Anna-Leonie, M.; Reijnen, M.; Antonello, M.; Piazza, M.; Settembre, N.; Mouawad, N. J.; Tsilimparis, N.; Dias, N.; Martinelli, O.; Frigatti, P.; Sirignano, P.; Chong, P.; Bevis, P.; Dimuzio, P.; Henke, P.; Duppers, P.; Holt, P.; Helmio, P.; Vriens, P.; Pulli, R.; Bellosta, R.; Micheli, R.; Veeraswamy, R.; Cuff, R.; Chiappa, R.; Gattuso, R.; Pini, R.; Dalman, R. L.; Milner, R.; Scali, S. T.; Bahia, S.; Laukontaus, S.; Trimarchi, S.; Fernandez-Alonso, S.; Deglise, S.; Bellmunt-Montoya, S.; Hofer, S.; Yusuf, S. W.; Ronchey, S.; Bartoli, S.; Bonvini, S.; Camparini, S.; Fazzini, S.; Pirrelli, S.; Horer, T.; Bisdas, T.; Vasudevan, T.; Lattmann, T.; Wyss, T. R.; Maldonado, T.; Pfammatter, T.; Kolbel, T.; Jakimowicz, T.; Donati, T.; Tracci, M.; Bracale, U. M.; Tolva, V. S.; Riambau, V.; Palazzo, V.; Makaloski, V.; Von Allmen, R. S.; Dorigo, W.; Mansour, W.; Van den Eynde, W.. - In: JOURNAL OF VASCULAR SURGERY. - ISSN 0741-5214. - 80:3(2024), pp. 937-945. [10.1016/j.jvs.2024.03.007]
The sac evolution imaging follow-up after endovascular aortic repair: An international expert opinion-based Delphi consensus study
Kahlberg A.Membro del Collaboration Group
;Melissano G.Membro del Collaboration Group
;
2024-01-01
Abstract
Objective: Management of follow-up protocols after endovascular aortic repair (EVAR) varies significantly between centers and is not standardized according to sac regression. By designing an international expert-based Delphi consensus, the study aimed to create recommendations on follow-up after EVAR according to sac evolution. Methods: Eight facilitators created appropriate statements regarding the study topic that were voted, using a 4-point Likert scale, by a selected panel of international experts using a three-round modified Delphi consensus process. Based on the experts' responses, only those statements reaching a grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final document. Results: One-hundred and seventy-four participants were included in the final analysis, and each voted the initial 29 statements related to the definition of sac regression (Q1-Q9), EVAR follow-up (Q10-Q14), and the assessment and role of sac regression during follow-up (Q15-Q29). At the end of the process, 2 statements (6.9%) were rejected, 9 statements (31%) received a grade B consensus strength, and 18 (62.1%) reached a grade A consensus strength. Of 27 final statements, 15 (55.6%) were classified as grade I, whereas 12 (44.4%) were classified as grade II. Experts agreed that sac regression should be considered an important indicator of EVAR success and always be assessed during follow-up after EVAR. Conclusions: Based on the elevated strength and high consistency of this international expert-based Delphi consensus, most of the statements might guide the current clinical management of follow-up after EVAR according to the sac regression. Future studies are needed to clarify debated issues.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
