VSASM 2019: “Extreme care” needed not to overgeneralise when creating AAA guidelines using RCT data

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Jan Blankensteijn (Amsterdam, Netherlands) talks to BLearning Aortic at VSASM 2019 (Vascular Societies’ Annual Scientific Meeting; 27–29 November, Manchester, UK) following his Kinmonth Lecture presentation titled ‘The current status of EVAR—Two decades of daydreams and nightmares’.

Blankensteijn talks about the highs and lows associated with endovascular aneurysm repair (EVAR) over the last two decades and says that although it seems like we have come a long way, actually “we are only just starting”. The big question currently, notes Blankensteijn, is “which patients really benefit from EVAR”. Blankensteijn says the beginnings of EVAR was “the most fantastic realisation” but that there have been an “enormous” number of the failures and complications as well.

The randomised evidence in the EVAR space is small, notes Blankesnteijn and, although randomised controlled trials (RCTs) are “extremely important and helps us to inform the patients”, one of the “nightmares” is that RCT data is being used to construct abdominal aortic aneurysm (AAA) guidelines in day-to-day practice which Blankensteijn believes should be done with “extreme care not to over generalise”.

He concludes by looking at the future direction of EVAR, which he says will likely include more complex devices that better suit individual patients.

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