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 / G. Tinelli, M. D'Oria, S. Sica, K. Mani, Z. Rancic, T. Andrew Resch, F. Beccia, A. Azizzadeh, M. Martins Da Volta Ferreira, M. Gargiulo, S. Lepidi, Y. Tshomba, G. S Oderich, S. Haulon, A. W Beck, A. Hertault, A. Savlania, A. Froio, A. Giaquinta, A. Zimmermann, A. Psyllas, A. Wanhainen, A. Ascoli Marchetti, A. Brito Queiroz, A. Kahlberg, A. Reyes-Valdivia, A. Schanzer, A. Tambyraja, A. Freyrie, A. Lorido, A. Millon, A. Ippoliti, B. Abai, B. Mees, B. Reutersberg, B. Maurel, B. Michel, C. Magnus Wahlgren, C. Cavazzini, C. Setacci, C. Jun Lee, C. Ferrer, C. Bicknell, C. Raphaël, D. Clair, D. L Dawson, D. J Arnaoutakis, D. Böckler, D. Kotelis, E. Mujagic, E. Chisci, E. Cieri, E. Gallitto, E. Maria Marone, E. Ducasse, F. Verzini, F. Pecoraro, F. Serracino-Inglott, F. Benedetto, F. Speziale, F. Stilo, F. Álvarez-Marcos, G. Pagliariccio, G. Piffaretti, G. Lanza, G. Philipp, G. Geenberg, G. Jung, G. Melissano, G. Franco Veraldi, G. Parlani, G. Faggioli, G. de Donato, G. Simonte, G. Colacchio, G. De Caridi, G. Pratesi, G. Spinella, G. Torsello, G. Wei Leong Tan, G. A Magee, H. Verhagen, H. Andrew, I. Koleilat, J. Westley Ohman, J.P.P. M de Vries, J. Budtz-Lilly, J. Black, J. Eldrup-Jorgensen, J. Hockley, J. Bath, J. Sobocinski, J. A van Herwaarden, K. Reinhard, K. C Orion, K. Amankwah, L. Bertoglio, L. di Marzo, L. Garriboli, L. Rizzo, M. Hakimi, M. Sheahan, M. Khashram, M. Schermerhorn, M. Lescan, M. Conrad, M. G Davies, M. Czerny, M. Orrico, M. J Eagleton, M. R Smeds, M. Taurino, M. Wohlauer, M. J Sharafuddin, M. Anna-Leonie, M. Reijnen, M. Antonello, M. Piazza, N. Settembre, N. J Mouawad, N. Tsilimparis, N. Dias, O. Martinelli, P. Frigatti, P. Sirignano, P. Chong, P. Bevis, P. Dimuzio, P. Henke, P. Düppers, P. Holt, P. Helmiö, P. Vriens, R. Pulli, R. Bellosta, R. Micheli, R. Veeraswamy, R. Cuff, R. Chiappa, R. Gattuso, R. Pini, R. L Dalman, R. Milner, S. T Scali, S. Bahia, S. Laukontaus, S. Trimarchi, S. Fernandez-Alonso, S. Deglise, S. Bellmunt-Montoya, S. Hofer, S. W Yusuf, S. Ronchey, S. Bartoli, S. Bonvini, S. Camparini, S. Fazzini, S. Pirrelli, T. Hörer, T. Bisdas, T. Vasudevan, T. Lattmann, T. Rudolf Wyss, T. Maldonado, T. Pfammatter, T. Kölbel, T. Jakimowicz, T. Donati, M. Tracci, U. Marcello Bracale, V. Stefano Tolva, V. Riambau, V. Palazzo, V. Makaloski, R. S Von Allmen, W. Dorigo, W. Mansour, W. Van den Eynde. - In: JOURNAL OF VASCULAR SURGERY. - ISSN 0741-5214. - 80:3(2024 Sep), 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
S. Trimarchi;
2024
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.
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