Abstract 18196: Excellent Incorporation of Endovascular Aneurysm Repair After Telementoring Program in a Secondary Care Center
BACKGROUND Telemedicine is a developing application which enhances mentoring and technical support for medical operators. Endovascular aneurysm repair (EVAR) represents a minimally invasive approach requiring an extensive training. Telementoring could thus represent a complementary feasible strategy to incorporate such a kind of new skills.
OBJECTIVE To evaluate, at a secondary care center, a 6-year follow-up after a telementoring program for distant teaching and training in EVAR.
METHODS A telementoring protocol using a stepwise introduction of EVAR had been established between a dedicated secondary vascular care center and a very experienced interventionist from a tertiary university care center. From March 1999 to April 2003 the secondary care center team was telementored through 48 EVAR procedures at its local setting. Telementoring was performed using 3 online audio-video-facilities monitoring fluoroscopic images, IVUS images and operating field respectively. Images were transmitted using 4 ISDN lines. From May 2003 to December 2009 the secondary care center team tracked its 76 cases after the telementoring program.
RESULTS There was no significant difference between telementored and not-telementored procedures either in peri-interventional mortality rate (4.2% vs 2.6%, χ2 test p=0.6375) or in initial technical success rate (91.7% vs 98.7%, χ2 test p=0.0530). 37 Endoleaks (EL) appeared in 26 patients (54.2%) who underwent a telementored procedure while 37 EL appeared in 35 patients (46.1%) who performed a not-telementored intervention, with no significant difference between the two groups (χ2 test p=0.3787). The rate of reinterventions (80% of which by endovascular approach) was significantly higher among telementored procedures than among not-telementored interventions (33.3% vs 15.8%, χ2 test p=0.0229).
CONCLUSIONS Despite the relatively rudimentary level of teletransmission, the 6-year follow-up evaluation after a telementoring program performed in a second care center demonstrates excellent incorporation of EVAR into community practice. Moreover, the learning curve achievement influenced technical results as demonstrated by the significant lower reinterventions rate among not-telementored procedures.
- © 2012 by American Heart Association, Inc.