title: Getting the aorta pants in place: a 'community of guidance' in the evolving practice of vascular implant surgery.
abstract: The evolving nature of surgical treatments creates gaps between evidence-based guidelines and actual clinical practice.This article addresses the emerging clinical practice of the EndoVascular Aneurysm Repair (EVAR), a surgical treatment of patients with Abdominal Aortic Aneurysm (AAA). Drawing on a qualitative study across three hospitals, we identified three interplaying expertise traits: the collective, the interpersonal and the technical, each being present to promote surgical work. The evolvement of EVAR is contextualized within technical artefacts and patient characteristics, along with a joint decision approach. The intertwinement between various expertise traits and contextual factors forms a 'community of guidance', nourishing further EVAR innovation without formalized institutions, evidence, training or guidelines. However, the lack of a shared context limits the transfer of evolving knowledge across hospital boundaries.
authors.affiliation: Sør-Trøndelag University College, NO-7489 Trondheim, Norway. berit.j.brattheim@ntnu.no
authors.forename: Berit
authors.initials: B
authors.lastname: Brattheim
authors.forename: Arild
authors.initials: A
authors.lastname: Faxvaag
authors.forename: Aksel
authors.initials: A
authors.lastname: Tjora
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data*; D002983:Clinical Competence; D003657:Decision Making; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D007407:Interviews as Topic; D009664:Norway; D014656:Vascular Surgical Procedures / Q000379:methods*