Multidisciplinary Endovascular Team, University College London Hospitals, London, UK.
Br J Surg. 2012 Feb;99(2):217-24. doi: 10.1002/bjs.7811.
Endovascular technology has advanced rapidly in the development of fenestrated endovascular aneurysm repair (FEVAR). Current evidence for endovascular aneurysm repair is limited to infra-renal aortic aneurysms. With increased costs and complexity of FEVAR, its current role is unclear. A national multicentre, cross-disciplinary consensus model was developed to propose indications for FEVAR.
All UK FEVAR centres and a wide selection of high-volume aneurysm treatment centres were invited to participate. The RAND appropriateness methodology was used. Five key steps were undertaken: meta-analysis of current literature; survey of current UK practice; nominal group establishment and definition of key clinical attributes; round 1--online survey of case vignettes; and round 2--nominal group consensus meeting.
More than 90 per cent of UK FEVAR centres participated. Literature review showed heterogeneous case series with no clear indications for use of FEVAR. Survey of current practice showed wide variations in aneurysm management. Consensus agreement on the role of FEVAR was achieved in 68·8 per cent of cases. Consensus for FEVAR was agreed in areas of moderate risk from open repair and need for suprarenal clamping, but it was less likely to be indicated in patients aged 85 years or more with 5·5-6-cm aneurysms, or short-necked infrarenal aortic aneurysms.
These data record areas of agreement and define the grey area of equipoise. Consequently, guidelines and recommendations can be developed on the indications for FEVAR to inform clinicians, commissioners and health economists.
腔内技术在腔内修复（FEVAR）的发展中取得了迅速进展。目前腔内动脉瘤修复的证据仅限于肾下主动脉瘤。随着 FEVAR 的成本增加和复杂性增加，其当前作用尚不清楚。建立了一个全国性的多学科交叉共识模型，提出了 FEVAR 的适应证。
邀请所有英国 FEVAR 中心和广泛选择的大容量动脉瘤治疗中心参加。采用 RAND 适宜性方法。进行了五个关键步骤：对当前文献进行荟萃分析；对英国目前的实践进行调查；确定关键临床属性的名义小组建立和定义；第一轮——在线案例描述调查；第二轮——名义小组共识会议。
超过 90%的英国 FEVAR 中心参与了研究。文献回顾显示，病例系列具有异质性，没有明确的 FEVAR 使用指征。目前的实践调查显示，动脉瘤管理存在广泛差异。在 68.8%的病例中，达成了对 FEVAR 作用的共识。在需要开放修复和肾上夹闭的中度风险以及在年龄为 85 岁或以上的患者中，有 5.5-6cm 的动脉瘤或短颈肾下主动脉瘤的情况下，同意 FEVAR 的作用，但不太可能指示。
这些数据记录了共识领域，并定义了平衡的灰色地带。因此，可以制定关于 FEVAR 适应证的指南和建议，为临床医生、决策者和卫生经济学家提供信息。
