Telementoring during endovascular treatment of abdominal aortic aneurysms: A prospective study
Telementoring during endovascular treatment of abdominal aortic aneurysms: A prospective study
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DOI：
10.1583/04-1421.1
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发表时间：
2005-04-01
影响因子：
2.6
通讯作者：
Gallino, A
中科院分区：
文献类型：
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作者：
Di Valentino, M;Alerci, M;Gallino, A
目的：探讨远程监护在腹主动脉瘤腔内修复术（EVAR）远程教学和培训中的应用。方法：根据前瞻性设计的研究方案，48例腹主动脉瘤腔内修复术患者：前12例患者（A组）在二级医疗中心由经验丰富的介入医生进行治疗，并培训当地团队;另外12名患者（B组）由当地团队在其二级中心进行手术，并由来自相邻套间的经验丰富的操作员进行远程监护;最后24例患者（C组）由当地团队在三级护理中心有经验的干预医生的远程远程监护支持下进行手术。使用3个视频源进行远程监控;使用4条ISDN线路传输图像。腹主动脉瘤腔内修复术使用血管内超声和同步荧光透视进行，以获得腹主动脉及其分支的路径图，以及识别肾动脉的起源，评估主动脉瘤颈，并监测覆膜支架近端和远端的附着。前12名患者（B组）的远程监护平均持续时间为2.1小时，其余24名患者（C组）的远程监护平均持续时间为1.2小时。手术持续时间无差异（A组为127 +/- 59分钟，B组为120 +/- 4分钟，C组为119 +/- 39分钟; p = 0.94）或在ICU的平均时间（A组26 +/- 15小时，B组22 +/- 2小时，C组22 +/- 11小时; p = 0.95）。仅C组与A组的住院时间（A组11 +/- 4天，B组9 +/- 4天，C组7 +/- 1天; p = 0.002）存在显著差异（p = 0.002）。只有1例（8.3%）患者（A组：由经验丰富的术者进行腹主动脉瘤腔内修复术）因髂动脉破裂需要转为开放手术。这是整个研究组中唯一的转换（和唯一的死亡）（A组1/12 vs B + C组0/36，p = 0.31）。结论：腹主动脉瘤腔内修复术的远程监测是可行的，并显示出有希望的结果。它可以作为开发类似项目的模型，用于教授心血管医学中的其他侵入性程序。
Purpose: To explore the use of telementoring for distant teaching and training in endovascular aortic aneurysm repair (EVAR).Methods: According to a prospectively designed study protocol, 48 patients underwent EVAR: the first 12 patients (group A) were treated at a secondary care center by an experienced interventionist, who was training the local team; a further 12 patients (group B) were operated by the local team at their secondary center with telementoring by the experienced operator from an adjacent suite; and the last 24 patients (group C) were operated by the local team with remote telementoring support from the experienced interventionist at a tertiary care center. Telementoring was performed using 3 video sources; images were transmitted using 4 ISDN lines. EVAR was performed using intravascular ultrasound and simultaneous fluoroscopy to obtain road mapping of the abdominal aorta and its branches, as well as for identifying the origins of the renal arteries, assessing the aortic neck, and monitoring the attachment of the stent-graft proximally and distally.Results: Average duration of telementoring was 2.1 hours during the first 12 patients (group B) and 1.2 hours for the remaining 24 patients (group C). There was no difference in procedural duration (127 +/- 59 minutes in group A, 120 +/- 4 minutes in group B, and 119 +/- 39 minutes in group C; p = 0.94) or the mean time spent in the ICU (26 +/- 15 hours in group A, 22 +/- 2 hours in group B, and 22 +/- 11 hours for group C; p = 0.95). The length of hospital stay (11 +/- 4 days in group A, 9 +/- 4 days in group B, and 7 +/- 1 days in group C; p = 0.002) was significantly different only for group C versus A (p = 0.002). Only 1 (8.3%) patient (in group A: EVAR performed by the experienced operator) required conversion to open surgery because of iliac artery rupture. This was the only conversion (and the only death) in the entire study group (1/12 in group A versus 0/36 in groups B + C, p = 0.31).Conclusions: Telementoring for EVAR is feasible and shows promising results. It may serve as a model for development of similar projects for teaching other invasive procedures in cardiovascular medicine.