VASSA Position Statement on Complex Aortic Endovascular Procedures

Background:

FEVAR, and BEVAR are novel endovascular techniques used to treat complex aortic pathology. They require expensive technology, and operators require extensive training and experience to execute these procedures correctly and successfully:

Training:

VASSA believes strongly that these procedures should be done by a Vascular surgeon. It is inappropriate for a General Surgeon or Interventionalist to proceed with this kind of procedure without the input of a Vascular Surgeon. (See below – MDT)

Proctoring:

The Vascular Surgeon will have been proctored through a minimum of 5 cases before operating without proctoring. The proctor will give an assessment of competence before the Vascular Surgeon is cleared as adequately trained in the procedure.

Equipment:

Hybrid operating room is mandatory.These complex procedures cannot be done safely with a mobile C-arm in a standard theatre – radiation issues are significant, meaning that staff and Patient safety may be compromised if a C-arm is used.

MDT:

VASSA has started an initiative called THE AORTIC WORKING GROUP. We will be hosting regular meetings to discuss complex aortic pathologies, procedures and outcomes etc.
Ideally these cases should be presented to a MDT, consisting of a minimum of 3 specialists, drawn from Intensivists, Radiologists (with a vascular imaging interest), Anaesthetists, Cardiologists, and Vascular Surgeon. Especially early in the experience of using these advanced techniques, it needs to be clearly understood that collegial input is likely to lead to better case selection, and thus better surgical outcomes. Non-VASSA members, members of the Trade, Trainees, and any Specialists with an interest in these procedures will be encouraged to attend meetings of the MDT as an educational exercise. Any surgeons with cases who require FEVAR or BEVAR will be encouraged to present their cases to the MDT, even if they are not VASSA members.