The Endovascular Preprocedural Run Through and Brief: A Simple Intervention to Reduce Radiation Dose and Contrast Load in Endovascular Aneurysm Repair

Abstract

Objectives: To assess the impact of a quality assured planning and sizing process and the endovascular team briefing (preprocedure run through and brief -PRTB) on the delivery of endovascular aneurysm repair (EVAR), in Edinburgh. Design: Prospective observational study, comparing parameters before and after the intervention. Materials: Prospectively collected database recording infrarenal aneurysms treated with EVAR performed from January 2007 to April 2014 at our institution. The total screening time, iodinated contrast volume used, radiation dose, endovascular training opportunities, and hospital length of stay were recorded. Methods: A comparison before (January 2007 to November 2011) and after (December 2011 to April 2014) the introduction of the PRTB was made for each of these variables. Multiple linear regression analysis was performed to account for the learning effect. Results: In this study, 61 EVAR cases were performed prior to and 44 EVAR cases after the introduction of the PRTB. Univariate Mann-Whitney tests suggested a significant difference between before PRTB introduction and after PRTB introduction on all outcome variables except procedure time. Multiple linear regression analysis results showed a statistically significant improvement in outcomes after the change point for all outcomes except for radiation dose. Endovascular training opportunities were realized in 12/61 (20%) before compared to 42/44 cases (95%) after PRTB introduction. Conclusions: By introducing rigorous quality assurance and utilizing the principles of crew resource management to the EVAR process, it is possible to reduce screening times, contrast use, hospital length of stay, and improve endovascular training opportunities.

Roteiro de estudo na correção endovascular dos aneurismas de aorta abdominal através do software OsiriX

“…(23) No Serviço de Alta Complexidade em Cirurgia Endovascular do Hospital de Clínicas da Universidade Estadual de Campinas (HC-Unicamp), refletindo esta tendência mundial, tem crescido anualmente o número de procedimentos endovasculares. Somente no ano de 2015, foram realizadas neste serviço 44 cirurgias deste porte.Por envolver reconhecidamente complicações relacionadas ao uso de contraste, perdas sanguíneas substanciais, assim como riscos potenciais aos doentes e equipe cirúrgica derivada de exposição à radiação ionizante, qualquer intervenção no intuito de melhorar a eficiência do procedimento e sua segurança merece sérias reflexões (41). Por isso, na tentativa de otimizar a técnica de execução da REVA pela Disciplina de Moléstias Vasculares do HC-Unicamp, iniciou-se um Projeto Piloto, que fundamentava-se na otimização da manipulação de imagens tomográficas de doentes submetidos a REVA.Escolheu-se, por conveniência, o software OsiriX -por ser um programa de plataforma operacional Apple de fácil acesso e com versão gratuita disponível para download (para uso domiciliar em computador pessoal), amplamente difundido entre os cirurgiões vasculares e cursos em congressos.…”