Learning Curve for Endovascular Abdominal Aortic Aneurysm Repair: Evaluation of a 277-Patient Single-Center Experience

Lobato, Armando C.; Rodriguez‐Lopez, Julio A.; Diethrich, Edward B.

doi:10.1177/152660280200900302

Cited by 56 publications

(40 citation statements)

References 26 publications

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“…Numerous interventional procedures, such as percutaneous coronary interventions, carotid artery stenting, endovascular aortic aneurysm repair, pulmonary valve implantation, and percutaneous balloon mitral valvuloplasty have evidence of a clear learning curve (31)(32)(33)(34)(35). The present study also shows that this is true for TAVI; a definite procedure-related learning curve was seen as evidenced by our decreased procedural and fluoroscopy times with reduced contrast volume and complications.…”

Section: Discussionsupporting

confidence: 67%

Transcatheter Aortic Valve Implantation

Alli¹,

Booker²,

Lennon³

et al. 2012

JACC: Cardiovascular Interventions

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Section: Discussionsupporting

confidence: 67%

Transcatheter Aortic Valve Implantation

Alli¹,

Booker²,

Lennon³

et al. 2012

JACC: Cardiovascular Interventions

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“…LEE et al (22) in their experience concluded that the learning curve is important for the reduction of the perioperative complications, but doesn't influence the technical success of the procedure. LOBATO et al (23) have shown that 55 endovascular aneurysm repairs were necessary to achieve optimal results ; and that the interval between the procedures was also important, with one case every 10 days being the minimal workload to achieve these success rates. FORBES et al (24) in their analysis suggested that 60 elective endovascular repairs, or 20 with a specific device, are required to obtain optimal initial clinical success.…”

Section: Discussionmentioning

confidence: 99%

Early Complications in Endovascular Treatment of Abdominal Aortic Aneurysm

Gabrielli

Baudo

Molinari

et al. 2004

Acta Chirurgica Belgica

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Abstract.Objective : The incidence of perioperative complications during endovascular repair of abdominal aortic aneurysm (EVAR) is reported in limited series. The aim of this study is to evaluate a multi-center survey of unexpected intraprocedural critical events of EVAR. Methods : A questionnaire relative to intraprocedural complications during EVAR was sent to major vascular surgery divisions in Italy. Eleven answered to the survey. The data obtained are relative to 1696 procedures. Results : A wide range of incidence of critical events was observed, from a lower value of 2.7% to a higher value of 68.8% (mean 21.16%). The problems relative to the insertion phase of the delivery system were 7.7%. Endoleaks were reported in 5.5% of cases. Stent graft release was problematic in 0.4% of cases and in another 0.4% there was a problem in shaft retrieval. Unintentional coverage of renal or polar arteries occurred in 0.8% of the procedures ; hypogastric arteries were unwillingly excluded in 2.7% of cases. Aortic or iliac artery rupture had an incidence of 0.7% ; arterial dissection occurred in 0.9%, atheroembolism in 0.5%, lower limb ischemia due to graft limb kinks in 0.7% and to occlusion in 0.9%. Conclusions : Perioperative critical events represent a serious problem only in few cases of EVAR ; they are common but in many cases not predictable ; in most circumstances they can be easily corrected with adjunctive manoeuvres during the same procedure. There is a highly significant correlation between the total workload and the incidence of critical events ; these do not appear to be related to the learning curve.

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“…In the conventional design, clinician investment may make them inclined to deliver other beneficial aspects of care more aggressively to patients receiving their preferred intervention. One can anticipate, in the EB design, that all clinicians will be aggressive in optimal management of their patients [4][5][6].…”

Section: Advantages Of the Eb Designmentioning

confidence: 99%

Statistical issues in the design and analysis of expertise‐based randomized clinical trials

Walter

Ismaila

Devereaux

2008

Statistics in Medicine

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SUMMARYIn order to avoid certain difficulties with the conventional randomized clinical trial design, the expertise-based design has been proposed as an alternative. In the expertise-based design, patients are randomized to clinicians (e.g. surgeons), who then treat all their patients with their preferred intervention. This design recognizes individual clinical preferences and so may reduce the rates of procedural crossovers compared with the conventional design. It may also facilitate recruitment of clinicians, because they are always allowed to deliver their therapy of choice, a feature that may also be attractive to patients.The expertise-based design avoids the possibility of so-called differential expertise bias. If a standard treatment is generally more familiar to clinicians than a new experimental treatment, then in the conventional design, more patients randomized to the standard treatment will have an expert clinician, compared with patients randomized to the experimental treatment. If expertise affects the study outcome, then a biased comparison of the treatment groups will occur.We examined the relative efficiency of estimating the treatment effect in the expertise-based and conventional designs. We recognize that expected patient outcomes may be better in the expertisebased design, which in turn may modify the estimated treatment effect. In particular, a larger treatment effect in the expertise-based design can sometimes offset a higher standard error arising from the confounding of clinician effects with treatments.These concepts are illustrated with data taken from a randomized trial of two alternative surgical techniques for tibial fractures.

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Learning Curve for Endovascular Abdominal Aortic Aneurysm Repair: Evaluation of a 277-Patient Single-Center Experience

Cited by 56 publications

References 26 publications

Transcatheter Aortic Valve Implantation

Transcatheter Aortic Valve Implantation

Early Complications in Endovascular Treatment of Abdominal Aortic Aneurysm

Statistical issues in the design and analysis of expertise‐based randomized clinical trials

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