A structured mental rehearsal before critical stages of procedures may reduce the rate and severity of intraoperative error.

Deterioration in renal function has been described after endovascular repair of abdominal aortic aneurysms (EVR). The aetiology is multifactorial and represents an important therapeutic target. A need exists to quantitatively summarise incidence and severity of renal dysfunction after EVR to allow better-informed attempts to preserve renal function and improve life expectancy. A systematic search was performed using Medline and Embase for renal function after EVR applying PRISMA statements. Univariate and multivariate random effects meta-analyses were performed to estimate pooled post-operative changes in serum creatinine and creatinine clearance at four time points after EVR: 0-7 days, 30 days/1 month, 1 month-1year and ≥1year. Clinically relevant deterioration in renal function was also estimated at ≥1year after EVR. 23 papers were identified for analysis. Pooled probability of clinically-relevant deterioration in renal function ≥1year was 18% (95% CI=14-23%,I²=82.5%). From univariate meta-analyses, serum creatinine increased after EVR by of 0.05mg/dL at 30 days/1month, 0.09mg/dL at 1 month to 1 year and 0.11mg/dL at ≥ 1 year (all p<0.05). Creatinine clearance reduced after EVR by 5.65 ml/min at 1 month-1 year and 6.58 ml/min at ≥1 year (both p<0.05). Renal failure after EVR is underreported and reporting standards are poorly followed. Clinically relevant deterioration in renal function is common and merits focussed attention to attenuate impact on long-term mortality.

The rate of misdiagnosis of rAAA has remained consistent over time and is concerning. There is a need for an effective clinical decision tool to enable accurate diagnosis and triage at the scene of the emergency.

Existing data on predictors of post-EVAR complications are generally of poor quality and largely derived from retrospective studies. Few studies describing suggestions for stratified surveillance have been subjected to external validation. There is a need to refine risk prediction for EVAR failure and to conduct prospective comparative studies of personalized surveillance with standard practice.

Stent-graft repair provides a feasible treatment option for anatomically suitable PAAs. Further studies are required to optimize both patient selection and follow-up protocols.