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

Kosmas I Paraskevas; Marc L Schermerhorn; Stephan Haulon; Adam W Beck; Hence J M Verhagen; Jason T Lee; Eric L G Verhoeven; Jan D Blankensteijn; Tilo Kölbel; Sean P Lyden; Daniel G Clair; Gianluca Faggioli; Theodosios Bisdas; Mario D'Oria; Kevin Mani; Karl Sörelius; Enrico Gallitto; Jose Fernandes E Fernandes; Athanasios Katsargyris; Sandro Lepidi; Andrea Vacirca; Piotr Myrcha; Mark J W Koelemay; Armando Mansilha; Clark J Zeebregts; Rodolfo Pini; Nuno V Dias; Angelos Karelis; Michel J Bosiers; David H Stone; Maarit Venermo; Mark A Farber; Matthew Blecha; Germano Melissano; Vincent Riambau; Matthew J Eagleton; Mauro Gargiulo; Salvatore T Scali; Giovanni B Torsello; Mark K Eskandari; Bruce A Perler; Peter Gloviczki; Mahmoud Malas; Ronald L Dalman

doi:10.1016/j.jvs.2024.08.012

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

J Vasc Surg. 2024 Aug 13:S0741-5214(24)01712-9. doi: 10.1016/j.jvs.2024.08.012. Online ahead of print.

Authors

Kosmas I Paraskevas¹, Marc L Schermerhorn², Stephan Haulon³, Adam W Beck⁴, Hence J M Verhagen⁵, Jason T Lee⁶, Eric L G Verhoeven⁷, Jan D Blankensteijn⁸, Tilo Kölbel⁹, Sean P Lyden¹⁰, Daniel G Clair¹¹, Gianluca Faggioli¹², Theodosios Bisdas¹³, Mario D'Oria¹⁴, Kevin Mani¹⁵, Karl Sörelius¹⁶, Enrico Gallitto¹², Jose Fernandes E Fernandes¹⁷, Athanasios Katsargyris¹⁸, Sandro Lepidi¹⁹, Andrea Vacirca¹², Piotr Myrcha²⁰, Mark J W Koelemay²¹, Armando Mansilha²², Clark J Zeebregts²³, Rodolfo Pini¹², Nuno V Dias²⁴, Angelos Karelis²⁵, Michel J Bosiers²⁵, David H Stone²⁶, Maarit Venermo²⁷, Mark A Farber²⁸, Matthew Blecha²⁹, Germano Melissano³⁰, Vincent Riambau³¹, Matthew J Eagleton³², Mauro Gargiulo¹², Salvatore T Scali³³, Giovanni B Torsello³⁴, Mark K Eskandari³⁵, Bruce A Perler³⁶, Peter Gloviczki³⁷, Mahmoud Malas³⁸, Ronald L Dalman³⁹

Affiliations

¹ Department of Vascular Surgery, Red Cross Hospital, Athens, Greece. Electronic address: [email protected].
² Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
³ Aortic Center, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Paris Saclay University, Paris Saclay, France.
⁴ Division of Vascular Surgery and Endovascular Therapy, University of Alabama at Birmingham, Birmingham, AL.
⁵ Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
⁶ Division of Vascular Surgery, Stanford University School of Medicine, Stanford, CA.
⁷ Department of Vascular and Endovascular Surgery, General Hospital and Paracelsus Medical University, Nuremberg, Germany.
⁸ Department of Vascular Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
⁹ German Aortic Center, Department of Vascular Medicine, University Medical Center Eppendorf, Hamburg, Germany.
¹⁰ Department of Vascular Surgery, Cleveland Clinic, Cleveland, OH.
¹¹ Department of Vascular Surgery, Vanderbilt University Medical Center, Section of Surgical Sciences, Nashville, TN.
¹² Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy; Vascular Surgery Unit, IRCCS Sant'Orsola, Azienda Ospedaliero-Universitaria, Bologna, Italy.
¹³ Vascular Surgery Unit, IRCCS Sant'Orsola, Azienda Ospedaliero-Universitaria, Bologna, Italy.
¹⁴ Department of Vascular and Endovascular Surgery, Department of Clinical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
¹⁵ Section of Vascular Surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
¹⁶ Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
¹⁷ Department of Vascular Surgery, University of Lisbon, Lisbon Academic Medical Center, Lisbon, Portugal.
¹⁸ Department of Vascular and Endovascular Surgery, General Hospital and Paracelsus Medical University, Nuremberg, Germany; Second Department of Vascular Surgery, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
¹⁹ Clinic of Vascular Surgery III, Athens Medical Center, Athens, Greece.
²⁰ Department of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
²¹ Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
²² Department of Angiology and Vascular Surgery, Sao Joao University Hospital, University of Porto, Porto, Portugal.
²³ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²⁴ Vascular Center Malmö, Skåne University Hospital and Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.
²⁵ Department of Vascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland.
²⁶ Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
²⁷ Department of Vascular Surgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
²⁸ Vascular Surgery Division, Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC.
²⁹ Division of Vascular Surgery, Stritch School of Medicine, Loyola University of Chicago, Chicago, IL.
³⁰ Department of Vascular Surgery, Vita-Salute San Raffaele University School of Medicine, IRCCS San Raffaele Hospital, Milan, Italy.
³¹ Department of Vascular Surgery, Cardiovascular Institute, Hospital Clinic Barcelona, University of Barcelona, Barcelona, Spain.
³² Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
³³ Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, FL.
³⁴ Institute for Vascular Research, St. Franziskus Hospital, Münster, Germany.
³⁵ Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
³⁶ Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
³⁷ Division of Vascular and Endovascular Surgery, Gonda Vascular Center, Mayo Clinic, Rochester, MN.
³⁸ Division of Vascular and Endovascular Surgery, Department of Surgery, University of California San Diego Health System, San Diego, CA.
³⁹ Vascular Surgery, University of Bologna - DIMEC, Bologna, Italy.

PMID: 39147288
DOI: 10.1016/j.jvs.2024.08.012

Abstract

Objective: As a result of conflicting, inadequate or controversial data in the literature, several issues concerning the management of patients with abdominal aortic aneurysms (AAAs) remain unanswered. The aim of this international, expert-based Delphi consensus document was to provide some guidance for clinicians on these controversial topics.

Methods: A three-round Delphi consensus document was produced with 44 experts on 6 prespecified topics regarding the management of AAAs. All answers were provided anonymously. The response rate for each round was 100%.

Results: Most participants (42 of 44 [95.4%]) agreed that a minimum case volume per year is essential (or probably essential) for a center to offer open or endovascular AAA repair (EVAR). Furthermore, 33 of 44 (75.0%) believed that AAA screening programs are (probably) still clinically effective and cost effective. Additionally, most panelists (36 of 44 [81.9%]) voted that surveillance after EVAR should be (or should probably be) lifelong. Finally, 35 of 44 participants (79.7%) thought that women smokers should (or should probably/possibly) be considered for screening at 65 years of age, similar to men. No consensus was achieved regarding lowering the threshold for AAA repair and the need for deep venous thrombosis prophylaxis in patients undergoing EVAR.

Conclusions: This expert-based Delphi consensus document provides guidance for clinicians regarding specific unresolved issues. Consensus could not be achieved on some topics, highlighting the need for further research in those areas.

Keywords: AAA; Abdominal aortic aneurysm; Delphi; EVAR; Open surgical repair; Perioperative mortality.

Publication types

Review