The sac evolution imaging follow-up after endovascular aortic repair: An international expert opinion-based Delphi consensus study

Tinelli, Giovanni; D'Oria, Marika; Sica, Simona; Mani, K.; Rancic, Z.; Resch, T. A.; Beccia, Flavia; Azizzadeh, A.; Da Volta Ferreira, M. M.; Gargiulo, M.; Lepidi, S.; Tshomba, Yamume; Oderich, G. S.; Haulon, S.; Beck, A. W.; Hertault, A.; Savlania, A.; Froio, A.; Giaquinta, A.; Zimmermann, Thomas Alexander; 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, Carlo; 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, Francesco; Alvarez-Marcos, F.; Pagliariccio, G.; Piffaretti, G.; Lanza, Gaetano Antonio; 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, Marco Graziano; 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, Stefan; 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, Tommaso; 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.

doi:10.1016/j.jvs.2024.03.007

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.

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, T. 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. A., 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. G., 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., The sac evolution imaging follow-up after endovascular aortic repair: An international expert opinion-based Delphi consensus study, <<JOURNAL OF VASCULAR SURGERY>>, 2024; (Marzo): N/A-N/A. [doi:10.1016/j.jvs.2024.03.007] [https://hdl.handle.net/10807/281459]