TY - JOUR
T1 - REPAIRS Delphi
T2 - A UK and Ireland Consensus Statement on the Management of Infected Arterial Pseudoaneurysms Secondary to Groin Injecting Drug Use
AU - REPAIRS Collaborative
AU - MacLeod, Caitlin S.
AU - Nagy, John
AU - Radley, Andrew
AU - Khan, Faisel
AU - Rae, Nikolas
AU - Wilson, Michael S.J.
AU - Suttie, Stuart A.
AU - Munro, Euan N.
AU - Flett, Murray M.
AU - Hussey, Keith
AU - Wolf, Bernhard
AU - Jamieson, Russell W.
AU - Wallace, David
AU - Vesey, Alex T.
AU - McCaslin, James
AU - Wong, Peng
AU - Tenna, Adriano
AU - Badger, Stephen
AU - Harrison, Gareth
AU - Ghosh, Jon
AU - Al-Khaffaf, Haytham
AU - Torella, Francesco
AU - McBride, Richard
AU - Drinkwater, Susan
AU - Antoniou, George A.
AU - Bhasin, Neeraj
AU - Pradhan, Aniket
AU - Smith, George
AU - Coughlin, Patrick
AU - Brar, Ranjeet
AU - Elsherif, Mohamed
AU - Lau, Simon
AU - Peach, George
AU - Kulkarni, Sachin
AU - Brooks, Marcus
AU - Wijesinghe, Lasantha
AU - McCune, Ken
AU - Hopper, Neil
AU - Cowan, Andrew
AU - Hunter, Ian
AU - Mittapalli, Devender
AU - Garnham, Andrew
AU - Jones, Steven
AU - Rajagopalan, Sriram
AU - Tiwari, Alok
AU - Imray, Chris
AU - Atwal, Amarjit
AU - Bahia, Sandeep
AU - Jones, Keith G.
AU - Handa, Ashok
AU - Bowbrick, Ginny
AU - Nordon, Ian
AU - Button, Matthew
AU - Rudarakanchana, Nung
AU - D'Souza, Rovan
AU - Tai, Nigel
AU - Moxey, Paul
AU - Bicknell, Colin
AU - Gibbs, Richard
AU - Zayed, Hany
AU - Saratzis, Athanasios
AU - Kannan, Ramesh
AU - Batchelder, Andrew
AU - Chong, Peter Lee
AU - Rowlands, Timothy
AU - Hildebrand, Diane
AU - Thapar, Ankur
AU - Chaudhuri, Arindam
AU - Howard, Adam
AU - Metcalfe, Matthew
AU - Al-Jundi, Wissam
AU - Sayer, Gabriel
AU - Lewis, David
AU - Sohrabi, Soroush
AU - Woolgar, Justin
AU - Fligelstone, Louis
AU - Davies, Huw
AU - Hill, Susan
AU - Fulton, Greg
AU - Moneley, Daragh
AU - McDonnell, Ciaran
AU - Martin, Zenia
AU - Dowdall, Joseph
AU - Tierney, Sean
AU - Walsh, Stewart
AU - Medani, Mekki
AU - Gosi, Gergely
N1 - Publisher Copyright:
© 2024 The Author(s)
PY - 2024/10
Y1 - 2024/10
N2 - Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. Methods: A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. Results: Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computed tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. Conclusion: This comprehensive consensus statement provides a strong insight into the standard of care for these patients.
AB - Objective: Consensus guidelines on the optimal management of infected arterial pseudoaneurysms secondary to groin injecting drug use are lacking. This pathology is a problem in the UK and globally, yet operative management options remain contentious. This study was designed to establish consensus to promote better management of these patients, drawing on the expert experience of those in a location with a high prevalence of illicit drug use. Methods: A three round modified Delphi was undertaken, systematically surveying consultant vascular surgeons in the UK and Ireland using an online platform. Seventy five vascular surgery units were invited to participate, with one consultant providing the unit consensus practice. Round one responses were thematically analysed to generate statements for round two. These statements were evaluated by participants using a five point Likert scale. Consensus was achieved at a threshold of 70% or more agreement or disagreement. Those statements not reaching consensus were assessed and modified for round three. The results of the Delphi process constituted the consensus statement. Results: Round one received 64 (86%) responses, round two 59 (79%) responses, and round three 62 (83%) responses; 73 (97%) of 75 units contributed. Round two comprised 150 statements and round three 24 statements. Ninety one statements achieved consensus agreement and 15 consensus disagreement. The Delphi statements covered sequential management of these patients from diagnosis and imaging, antibiotics and microbiology, surgical approach, wound management, follow up, and additional considerations. Pre-operative imaging achieved consensus agreement (97%), with computed tomography angiography being the modality of choice (97%). Ligation and debridement without arterial reconstruction was the preferred approach at initial surgical intervention (89%). Multidisciplinary management, ensuring holistic care and access to substance use services, also gained consensus agreement. Conclusion: This comprehensive consensus statement provides a strong insight into the standard of care for these patients.
KW - Delphi consensus study
KW - Groin sepsis
KW - Infected arterial pseudoaneurysm
KW - Injecting drug use
KW - Intravenous drug user
KW - People who inject drugs
UR - https://www.scopus.com/pages/publications/85196857506
U2 - 10.1016/j.ejvs.2024.04.016
DO - 10.1016/j.ejvs.2024.04.016
M3 - Article
C2 - 38663765
AN - SCOPUS:85196857506
SN - 1078-5884
VL - 68
SP - 530
EP - 540
JO - European Journal of Vascular and Endovascular Surgery
JF - European Journal of Vascular and Endovascular Surgery
IS - 4
ER -