Editor's Choice – A Comparison of Computed Tomography Angiography and Colour Duplex Ultrasound Surveillance Post Infrarenal Endovascular Aortic Aneurysm Repair: Financial Implications and Impact of Different International Surveillance Guidelines,European Journal of Vascular and Endovascular Surgery

当前位置： X-MOL 学术 › Eur. J. Vasc. Endovasc. Surg. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Editor's Choice – A Comparison of Computed Tomography Angiography and Colour Duplex Ultrasound Surveillance Post Infrarenal Endovascular Aortic Aneurysm Repair: Financial Implications and Impact of Different International Surveillance Guidelines
European Journal of Vascular and Endovascular Surgery ( IF 5.7 ) Pub Date : 2021-06-14 , DOI: 10.1016/j.ejvs.2021.04.005
Luke Smith ₁ , Nicholas Thomas ₁ , Andrew Arnold ₁ , Rachel Bell ₂ , Hany Zayed ₂ , Mark Tyrrell ₂ , Soundrie Padayachee ₁

Affiliation

Objective

Use of colour duplex ultrasound (CDUS) and computed tomography angiography (CTA) for infrarenal endovascular aortic aneurysm repair (EVAR) surveillance differs in internationally published guidelines. This study aimed firstly to compare CDUS detection of significant sac abnormalities with CTA. Secondly, a sensitivity analysis was conducted to compare financial estimates of the, predominantly CDUS based, local and Society of Vascular Surgery (SVS) protocols, the risk stratified European Society of Vascular Surgery (ESVS) protocol, and the CTA based National Institute of Health and Care Excellence (NICE) protocol.

Methods

Agreement between CDUS and CTA was assessed for detection of significant sac abnormalities. Surveillance protocols were extrapolated from published guidelines and applied to infrarenal EVAR patients active on local surveillance at a large, single centre. Surveillance intensity was dependent on presence of endoleak and subsequent risk of treatment failure in accordance with surveillance recommendations. Estimates for each surveillance protocol were inclusive of a range of published incidences of endoleak, contrast associated acute kidney injury (AKI), and excess hospital bed days, and estimated for a hypothetical five year surveillance period.

Results

The kappa coefficient between CDUS and CTA for detecting sac abnormalities was 0.68. Maximum five year surveillance cost estimates for the 289 active EVAR patients were £272 359 for SVS, £230 708 for ESVS, £643 802 for NICE, and £266 777 for local protocols, or £1 270, £1 076, £3 003, and £1 244 per patient. Differences in endoleak incidence accounted for a 1.1 to 1.4 fold increase in costs. AKI incidence accounted for a 3.3 to 6.2 fold increase in costs.

Conclusion

A combined CTA and CDUS EVAR surveillance protocol, with CTA reserved for early seal assessment and confirmatory purposes, provides an economical approach without compromising detection of sac abnormalities. AKI, as opposed to direct imaging costs, accounted for the largest differences in surveillance cost estimates.

中文翻译：

编辑推荐——计算机断层扫描血管造影术和彩色双工超声监测肾下腔内主动脉瘤修复后的比较：不同国际监测指南的财务影响和影响

客观的

使用彩色双工超声 (CDUS) 和计算机断层扫描血管造影 (CTA) 进行肾下血管内主动脉瘤修复 (EVAR) 监测在国际发布的指南中有所不同。本研究首先旨在比较 CDUS 检测显着囊异常与 CTA。其次，进行了敏感性分析，以比较主要基于 CDUS 的本地和血管外科学会 (SVS) 协议、风险分层欧洲血管外科学会 (ESVS) 协议以及基于 CTA 的国家卫生研究院的财务估计和护理卓越 (NICE) 协议。

方法

CDUS 和 CTA 之间的一致性被评估以检测显着的囊异常。监测协议是从已发表的指南中推断出来的，并应用于在大型单一中心进行局部监测的肾下 EVAR 患者。根据监测建议，监测强度取决于内漏的存在和随后的治疗失败风险。每个监测方案的估计值包括一系列已公布的内漏、造影剂相关急性肾损伤 (AKI) 和额外住院天数的发生率，并估计了一个假设的五年监测期。

结果

CDUS 和 CTA 之间用于检测囊异常的 kappa 系数为 0.68。289 名活动性 EVAR 患者的最大五年监测成本估计为 SVS 272 359 英镑、ESVS 230 708 英镑、NICE 643 802 英镑和本地协议 266 777 英镑，或 1 270 英镑、1 076 英镑、3 英镑003，每位患者 1 244 英镑。内漏发生率的差异导致成本增加了 1.1 到 1.4 倍。AKI 发病率导致成本增加 3.3 至 6.2 倍。