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The impact of the proctor assistance for a safe learning curve in the development of a complex aortic endovascular program

2022Journal article Restricted access
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dc.contributor.authorMelo, Ryan
dc.contributor.authorFernandes E Fernandes, Ruy
dc.contributor.authorSalvado, Margarida
dc.contributor.authorDuarte, Antonio
dc.contributor.authorLopes, Alice
dc.contributor.authorVerhoeven, Eric
dc.contributor.authorFernandes E Fernandes, Jose
dc.contributor.authorPedro, Luís M
dc.date.accessioned2024-02-07T16:30:44Z
dc.date.available2024-02-07T16:30:44Z
dc.date.issued2022
dc.description© The Author(s) 2022.pt_PT
dc.description.abstractIntroduction: Initiating an endovascular aortic program for treatment of complex aortic aneurysms with fenestrated and branched grafts (FB-EVAR) is challenging. Using a Proctor is one option for training and development of the team. However, this approach has not been formally analyzed. The aim of this study was to analyze the learning curve and the effect of the Proctor regarding safety and effectiveness in FB-EVAR. Methods: A single-center retrospective cohort study was performed, including all consecutive elective patients submitted to FB-EVAR (including both thoraco-abdominal-TAAA and complex abdominal aortic aneurysms-C-AAA) from 2013 to 2021. Patients were divided into 2 groups, the first operated with the Proctor present and the second without. Primary outcomes were 30-day mortality (safety) and technical and procedure success (efficacy). Secondary outcomes included treatment performance (procedure time, blood loss, contrast, and radiation use), re-interventions, aneurysm shrinking, target vessel patency, 30-day mortality, aneurysm-related mortality, and overall mortality. Results: Overall, 105 patients were included in the study, 35 operated with Proctor and 70 operated without. The first 20 patients were operated always with the Proctor, and the remaining were operated with the Proctor selectively. Mean age was 71.8 (±7.3) years and 95 patients were male (90.5%). Overall, 62 (65%) patients had C-AAA or extent IV TAAAs and 43 (35%) had extensive TAAAs. There were no significant differences regarding 30-day mortality (Log Rank=0.99), technical success (p=0.4), or procedure success (p=0.8). Mean surgical time was longer in the non-Proctor group (p=0.005), as well as significant intra-operative blood loss (p=0.042). Contrast use (p=0.5) and radiation (p=0.53) were non-significantly different between groups. There were no significant differences regarding length of stay (p=0.4), major adverse events (p=0.6), target vessel patency (Log Rank=0.97), early (p=0.7) and late endoleaks (0.7), aneurysm shrinking (p=0.6), re-interventions (p=0.2), and overall mortality (Log Rank=0.87). Conclusion: In our experience, the use of a Proctor to start and accompany our complex endovascular aortic program for FB-EVAR was both safe and effective and may serve as a template by other countries and centers that aim to developing their programs.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationJ Endovasc Ther. 2024 Feb;31(1):26-36pt_PT
dc.identifier.doi10.1177/15266028221105186pt_PT
dc.identifier.eissn1545-1550
dc.identifier.issn1526-6028
dc.identifier.urihttp://hdl.handle.net/10451/62497
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSagept_PT
dc.relation.publisherversionhttps://journals.sagepub.com/home/JETpt_PT
dc.subjectAortic centerpt_PT
dc.subjectBranchedpt_PT
dc.subjectComplex endovascular aortic repairpt_PT
dc.subjectFenestratedpt_PT
dc.subjectLearning curvept_PT
dc.subjectProctorpt_PT
dc.titleThe impact of the proctor assistance for a safe learning curve in the development of a complex aortic endovascular programpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage36pt_PT
oaire.citation.issue1pt_PT
oaire.citation.startPage26pt_PT
oaire.citation.titleJournal of Endovascular Therapypt_PT
oaire.citation.volume31pt_PT
person.familyNameGouveia e Melo
person.familyNameFernandes e Fernandes
person.familyNameDuarte
person.familyNameLopes
person.familyNameVerhoeven
person.familyNameFernandes e Fernandes
person.familyNamePedro
person.givenNameRyan
person.givenNameRuy
person.givenNameAntonio
person.givenNameAlice
person.givenNameEric
person.givenNameJose
person.givenNameLuís
person.identifier.ciencia-id211B-B548-CE4E
person.identifier.ciencia-idB710-641D-77AD
person.identifier.ciencia-id221A-0500-AB4F
person.identifier.ciencia-id8D12-0BD7-11B5
person.identifier.ciencia-id0B14-1812-24DC
person.identifier.orcid0000-0001-8327-6384
person.identifier.orcid0000-0003-1619-8851
person.identifier.orcid0000-0002-3867-6730
person.identifier.orcid0000-0002-1957-7614
person.identifier.orcid0000-0002-8080-1873
person.identifier.orcid0000-0002-2144-0430
person.identifier.orcid0000-0003-4310-9324
person.identifier.scopus-author-id39761284300
person.identifier.scopus-author-id57203041538
person.identifier.scopus-author-id6603638540
person.identifier.scopus-author-id7004454630
rcaap.rightsrestrictedAccesspt_PT
rcaap.typearticlept_PT
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relation.isAuthorOfPublication.latestForDiscovery44ec43be-8d0e-49ef-a1c2-0910c759a251

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