Variability In Proximal Neck Determination Among Vascular Surgeons
David Minion, MD, Daniel Badia, DO.
University of Kentucky, Lexington, KY, USA.
OBJECTIVE - The adequacy of proximal neck is key in the evaluation of suitability for endovascular repair. However, there is a wide variation in the IFU criteria of available grafts and no consensus definition of neck. The purpose of this study was to determine variability in measuring neck by vascular surgeons. METHODS - A repository of 12 anonymized scans was created by the primary investigator. The scans were chosen to represent a wide variety of common neck characteristics including normal, reversed conical, thrombus laden, angulated, short, suprarenal, and combinations of each. The scans were then evaluated by 5 other vascular surgeons in the same practice and a second-year vascular fellow for infrarenal neck length with no specific instructions other than to use their own standard criteria. They were also asked to classify the anatomy as eitherinfrarenal, juxtarenal, pararenal, suprarenal, paravisceral, or Type IV TAAA.RESULTS - The range of the neck length measurements submitted differed by as little as 2 mm in anatomy meant to represent suprarenal pathology to 64 mm in a long severely angulated neck. The standard deviation of neck length measurements for the twelve scans averaged 8 mm. Only one scan was unanimously classified by all seven participants. It was the scan chosen to represent normal anatomy and all agreed on an infrarenal description. CONCLUSIONS-Personal methods to determine neck length vary widely among vascular surgeons. Databases that rely on self-reported neck length or even anatomic classification are likely inconsistent. Methods for more simplified and standardized determinations are important for more meaningful outcomes research.
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