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Open surgery for AAA, NICE concludes

Thursday March 19th, 2020

Unruptured abdominal aortic aneurysms should usually be treated with open surgery rather than endovascular repair, according to the latest version of controversial guidelines published today.

Endovascular repair can be used where open surgery is contraindicated, according to the National Institute for Health and Care Excellence.

NICE has spent two years discussing the guidelines, which could see a significant shift in practice in some centres. It said that current practice "overwhelmingly" favours endovascular repair.

Paul Chrisp, from NICE, said: “We know that some clinicians prefer EVAR but what we are trying to do is steer the system to shift practice towards open surgery, in line with the evidence.

“There is a recognition that EVAR may have been used in some patients when open surgery would have been suitable, but that ‘do not offer’ EVAR is too inflexible to reflect the fact that assessment of individual patients by multidisciplinary teams for the most suitable management option, and involving them in treatment decisions, is how the system works.

“The revised wording reflects more fully the complex implementation issues associated with shifting a dominant practice in line with what the evidence indicates, gaining the support of the system and patients to start putting the recommendations into practice, and the need for practice to move towards open repair.”

Tags: Internal Medicine | NHS | UK News

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