title: Can surgeons assess CT suitability for endovascular repair (EVAR) in ruptured abdominal aortic aneurysm? Implications for a ruptured EVAR trial.
abstract: The purpose of this study was to determine whether surgeons without formal radiological training are able to assess suitability of patients with ruptured abdominal aortic aneurysms (AAA) for EVAR. The CT scans of 20 patients with AAA were reviewed under timed conditions by six vascular surgeons. Twenty minutes was allocated per scan. They were asked to determine if each aneurysm would be treatable by EVAR in the emergency setting and, if so, to measure for device selection. The results were then compared with those of a vascular radiologist. Six surgeons agreed on the suitability of endovascular repair in 45% of cases (95% CI, 23.1-68.5%; 9/20 scans; kappa = 0.41 [p = 0.01]) and concurred with the radiologist in eight of these. Individually, agreement ranged from 13 to 16 of the 20 scans, 65-80% between surgeons. The kappa value for agreement between all the surgeons and the radiologist was 0.47 (p = 0.01, moderate agreement). For the individual surgeons, this ranged from 0.3 to 0.6 (p = 0.01). In conclusion, while overall agreement was moderate between the surgeons and the radiologist, it is clear that if surgeons are to assess patients for ruptured EVAR in the future, focused training of surgical trainees is required.
authors.affiliation: Division of Cardiovascular Sciences, Vascular Surgery Group, University of Leicester, Leicester Royal Infirmary, Robert Kilpatrick Clinical Sciences Building, Leicester, LE2 7LX, UK. hsrayt@hotmail.com
authors.forename: Harjeet
authors.initials: H
authors.lastname: Rayt
authors.forename: Kelly
authors.initials: K
authors.lastname: Lambert
authors.forename: Matthew
authors.initials: M
authors.lastname: Bown
authors.forename: Guy
authors.initials: G
authors.lastname: Fishwick
authors.forename: Robert
authors.initials: R
authors.lastname: Morgan
authors.forename: Mark
authors.initials: M
authors.lastname: McCarthy
authors.forename: Nick
authors.initials: N
authors.lastname: London
authors.forename: Robert
authors.initials: R
authors.lastname: Sayers
mesh_terms: D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging* / Q000601:surgery; D017130:Angioplasty / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery; D002983:Clinical Competence; D002986:Clinical Trials as Topic; D003657:Decision Making; D005260:Female; D013502:General Surgery / Q000379:methods; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D015588:Observer Variation; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D011336:Probability; D015641:Radiography, Interventional / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed