Is the management of complex abdominal aortic aneurysms consistent across the UK? A questionnaire-based survey.

BACKGROUND: Our objective was to quantify variability across the UK in the management of a complex abdominal aortic aneurysm (AAA).

METHODS: An online survey was emailed to all members of the Vascular Society for Great Britain and Ireland. The survey presented a vignette of a 63-year-old woman with significant respiratory co-morbidity whose computed tomographic (CT) angiogram demonstrated a 54 mm AAA with a short (7 mm) proximal neck but no other adverse morphological features for a standard or complex endovascular aneurysm repair (EVAR). The survey included images and questions related to AAA management as well as surgeon access to operating facilities. 111 responses were received.

RESULTS: 47% of participants indicated a preference for continuing surveillance, 29% for fenestrated EVAR and 7% each for no operative intervention and open surgical repair. The remainder indicated various preferences including standard EVAR (3%), standard EVAR with endoanchors (3%), chimney EVAR (2%), EVAS (endovascular aneurysm sealing) (1%) and chimney EVAS (1%). Of the 47% who wanted to continue surveillance, once their threshold was reached, 73% would manage with a fenestrated EVAR, 17% with open repair and the remainder with standard EVAR with endoanchors (2%), EVAS (2%) or chimney EVAS (2%). 49% of participants carried out endovascular procedures in hybrid theatres, 36% in radiology angiosuites and 15% in standard operating theatres. The location had no significant effect on the consultant choice of treatment method.

CONCLUSIONS: The study results support anecdotal variation in practice among vascular specialists. This reflects the lack of solid evidence on the optimal management of complex AAA.