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The Leicester EVAR Follow Up Protocol/Clinic Guidelines

The Leicester EVAR Follow Up Protocol/Clinic Guidelines. Chris Bufton Lead Vascular Nurse Specialist Michelle Lapworth Vascular Nurse Specialist. Background. Follow up for the EVAR 1 & 2 research project was carried out initially by a research nurse.

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The Leicester EVAR Follow Up Protocol/Clinic Guidelines

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  1. The Leicester EVAR Follow Up Protocol/Clinic Guidelines Chris Bufton Lead Vascular Nurse Specialist Michelle Lapworth Vascular Nurse Specialist

  2. Background • Follow up for the EVAR 1 & 2 research project was carried out initially by a research nurse. • Following publication of the EVAR 1 data and subsequent NICE guidance there was an increase in the number of patients undergoing EVAR and therefore requiring long term follow up. • This prompted the development of Guidelines for the Nurse Led Service which was taken over by the Vascular Nurse Specialists. • This also formalised the follow up regimes for this group of patients. UHL/VNS/ML/CB/2012

  3. Purpose of the Protocol/Guidelines • To provide patients with continuing post-operative surveillance of their endovascular stent. • To identify any post-operative complications such as seroma formation, false aneurysm, or endoleak and to report these to the patient’s Consultant and treat appropriately. • The guideline has been developed for use by the Vascular Nurse Specialists. UHL/VNS/ML/CB/2012

  4. Training and Development • Included in the Guideline is a training and assessment package which must be completed by the Vascular Nurse Specialist. • Training is undertaken by the Consultant Vascular Surgeon or an appropriately trained Vascular Nurse Specialist. • Assessment of competence is undertaken by a Consultant Vascular Surgeon. UHL/VNS/ML/CB/2012

  5. Length of Follow Up • EVAR Trials suggested ongoing follow up for patients following EVAR. • Locally, it was decided that patients who have had endovascular repair of aortic aneurysm would be offered surveillance for a minimum of 10 years. • After 10 years individual cases are reviewed at the Aortic MDT and the patient may either be discharged or continue in follow up as agreed by the MDT on an individual basis. This may also be influenced by patient preference. UHL/VNS/ML/CB/2012

  6. The Clinics • Two outpatient EVAR clinics are held each week on a Monday morning • 20 patients • Nurse led • Vascular Technologist UHL/VNS/ML/CB/2012

  7. Conventional EVAR Follow Up Regime • Prior to DischargeDuplex scan, X-ray of Abdomen and iliacs AP and Lateral Intervals Post Discharge • 4- 6 weeks Consultant Clinic, Duplex scan • Three MonthsNurse Led Clinic, Duplex scan • Six Months Nurse Led Clinic, Duplex scan • One year Nurse Led Clinic, Duplex scan X-ray Abdomen and iliacs AP and Lateral • 1-5 Years Nurse Led Clinic, six monthly with Duplex scan, yearly X-ray of Abdomen and iliacs AP and lateral • 5-10 Years Nurse Led Clinic yearly, Duplex scan, and X-ray of Abdomen and iliacs AP and lateral • Review by MDT after 10 years re: further follow up UHL/VNS/ML/CB/2012

  8. Thoracic EVAR Follow up Regime • Prior to discharge Baseline Chest X-ray Intervals Post Discharge • 4- 6 weeks Consultant clinic review • 1 year CT scan • 2 yearsChest X-ray • Thereafter (On alternate years) CT one year and Chest X-ray next. • Review by MDT after 10 years re: further follow up UHL/VNS/ML/CB/2012

  9. Fenestrated EVAR Follow-up Regime • Prior to discharge Abdominal X-ray and Duplex Scan Intervals Post Discharge • 4 - 6 weeks Consultant clinic, Duplex scan, U&E’s, FBC, LFT’s • 3 months Nurse Led Clinic, CT Scan lower thorax, abdomen and iliacs, FBC and U&E’s, LFT’s • 6 months Nurse Led Clinic, Duplex Scan, FBC, U&E’s LFT’s • 1 year Nurse Led Clinic, Duplex scan, CT Scan lower thorax, abdomen and iliacs , FBC, U&E’s, LFT’s and Abdominal X-ray • Thereafter Nurse Led Clinic, Annual Duplex scan, abdominal X-ray and bloods in clinic with a CT scan lower thorax, abdomen to be arranged thereafter. Result of CT to patient by post after MDT discussion. UHL/VNS/ML/CB/2012

  10. EVAR Clinic Flow Chart • Included in the guideline is a flow chart to ensure that the correct action is taken dependent upon the result of the Duplex scan and/or any clinical findings. • This may require consultation with the On Call Vascular Consultant or further imaging. UHL/VNS/ML/CB/2012

  11. An Evolving Service • UHL policy dictates that guidelines are reviewed every 3 years. • However, technological developments and further research findings have driven the Vascular Team to review the Guidelines more frequently. • There is a multi-disciplinary approach to the development of and any changes to the guidelines. • Establishment of an Aortic MDT. UHL/VNS/ML/CB/2012

  12. Any Questions? UHL/VNS/ML/CB/2012

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