The use of human cadavers and virtual reality simulation in endovascular training: A questionnaire of patient and professional opinion

Abstract

s / International Journal of Surgery 11 (2013) 686e745 737 ABSTRACTS 0544: THE USE OF HUMAN CADAVERS AND VIRTUAL REALITY SIMULATION IN ENDOVASCULAR TRAINING: A QUESTIONNAIRE OF PATIENT AND PROFESSIONAL OPINION Stuart Maitland , Craig Nesbitt , Roger Searle , Gerard Stansby . 1 Freeman Hospital, NUT, Newcastle Upon Tyne, UK; Newcastle University, NUT, Newcastle Upon Tyne, UK. Aim: To establish the opinion of patients and clinicians on the use of virtual reality simulators (VRS) and human cadavers (HC) for endovascular training. Methods: Experts in interventional cardiology, radiology and vascular surgery rated their agreement to statements regarding endovascular simulation (HC and VRS) through an online questionnaire. Patients' views on endovascular simulation training were also sought. Results: 100 professionals completed questionnaires. < 25% were aware of endovascular HC training, none had first hand experience, five (5.6%) disagreed with its use. All candidates were aware of VRS, 80.9% had first hand experience. Many expressed interest in HC stating concerns regarding the realism of VRS. 107 patients (50 non-vascular, 57 vascular*) responded. All patients agreed with HC training. Patients declared greater confidence in doctors trained on HC versus VRS (p1⁄40.000). Conclusion: These are the first recorded opinions of professionals and patients regarding endovascular simulation training. Endovascular professionals question the suitability, appropriateness and feasibility of endovascular HC training, yet few are wholly satisfied with VRS. Patients appreciate the need for adjunctive simulation training, but harbor mistrust in computer technology. Enhanced patient education is required to maintain confidence and trust. * non-vascular patients have no history of vascular disease 0547: TYPE II ENDOLEAKS: LOW RISK OF RUPTURE AND HIGH RISK OF TREATMENT FAILURE David Sidloff, Philip Stather, Eddie Choke, Matt Bown, Robert Sayers. University of Leicester, Leicester, UK. Aim: To assess the risk of rupture and determine the benefits of intervention for the treatment of type II endoleaks after endovascular abdominal aortic aneurysm repair. Method: A systematic review was performed according to PRISMA guidelines. Outcome data including incidence, spontaneous resolution, sac expansion, interventions, success, and complications were recorded. Results: 32 non-randomised retrospective studies were included, totalling 21,728 patients, 1515 type II endoleaks and 392 interventions. This analysis reveals type II endoleaks have an incidence of 10% with 32.3% spontaneously resolving. 14 ruptures were reported (incidence 0.9%), from which 43% did not have concurrent sac expansion. Analysing interventions, 28% were unsuccessful. Translumbar embolization had a higher success rate compared to transarterial embolization (TL81% v TA62.5% P1⁄40.024) with fewer persistent endoleaks (TA36% Vs TL19% P1⁄40.0396). Transarterial embolizations had a higher associated number of complications (TA10% Vs TL0% P1⁄40.0426). Conclusion: This review has revealed that rupture secondary to an isolated type II endoleak is rare (<1%) and that over a third occur in the absence of sac expansion. Nearly a third of all interventions for the treatment of type II endoleaks fail, however a translumbar intervention has a higher success rate with a lower risk of complications. 0555: AN EVALUATION OF OUR EARLY EXPERIENCE OF PERCUTANEOUS EVAR USING THE PROSTAR XL DEVICE David Ormesher, Jenna Godfrey, Andrew Schiro, David Murray, Ferdinand Serracino-Inglott. Department of Vascular and Endovascular Surgery, Manchester Royal Infirmary, Manchester, UK. Introduction: There is a trend towards less invasive procedures in all areas of surgery. It is suggested that the use of percutaneous closure devices for endovascular procedures that require larger seat sizes may have a positive impact on patient outcomes. Methods: A retrospective review of our endovascular logbook was undertaken from which all patients who received a Prostar XL device were identified and data collected. Results: 96 Prostar XL devices were deployed. Mean skin to common femoral artery (CFA) depth was 31.3mm, all but 5 patients had some degree of CFA calcification. The median length of stay was 4 days. 4 patients went on to develop groin haematomas postoperatively; all of these were treated conservatively. The Prostar XL cut through the CFA in one patient and this required repair. 80% of complications were in the first 15 cases. Conclusion: No long-term complications in our series can be attributed to the percutaneous approach for EVAR. We believe that US-guided puncture can overcome problems associated with CFA calcification and that the depth from skin to CFA has no impact on morbidity. The use of low profile devices ( 16F) and operator experience have a positive impact on outcomes with the Prostar XL device. 0564: TEMPORAL ARTERY BIOPSY e TOO MANY TOO LATE? Ruth Graham, Lourdusamy Selvam. West Wales General Hospital,