The Preference for Open vs Endovascular Repair of AAA (PROVE-AAA) Trial:

Focusing on the Patient’s Preference for the Type of Repair

The PROVE-AAA Study TeamJune 15th, 2018

DISCLOSUREPhilip Goodney

• No relevant financial relationship reported

Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times

Journal of Vascular Surgery 2018 67(6)

Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times

Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times

Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times

Annals of Vascular Surgery 5(6):491-9 · December 1991 Cited 2,800 times

• Surgeons Like EVAR• Less Invasive• Lower operative

mortality

• Patients Like EVAR• Less Invasive• Lower mortality

• Surgeons Like EVAR• Less Invasive• Lower operative

mortality

• Patients Like EVAR• Less Invasive• Lower operative

mortality

• Surgeons Like EVAR• Less Invasive• Lower operative

mortality

• Patients Like EVAR• Less Invasive• Lower operative

mortality

Device Brand A

Device Brand B

Years After Repair

10 Year Reintervention-Free Survival In VQI

ProportionSurviving

Free From Re-intervention

Device Brand A

Device Brand B

Years After Repair

10 Year Reintervention-Free Survival In VQI

ProportionSurviving

Free From Re-intervention 40% of Patients In VQI Needed

Reintervention by 10 years

• Surgeons Like EVAR• Less Invasive• Lower mortality

• Patients Like EVAR• Less Invasive• Lower mortality

• Surgeons Don’t Follow Patients• Costly• Burdensome

• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves

• Surgeons Like EVAR• Less Invasive• Lower mortality

• Patients Like EVAR• Less Invasive• Lower mortality

• Surgeons Don’t Follow Patients• Costly• Burdensome

• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves

• Surgeons Like EVAR• Less Invasive• Lower mortality

• Patients Like EVAR• Less Invasive• Lower mortality

• Surgeons Don’t Follow Patients• Costly• Burdensome

• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves

• Surgeons Like EVAR• Less Invasive• Lower mortality

• Patients Like EVAR• Less Invasive• Lower mortality

• Surgeons Don’t Follow Patients• Costly• Burdensome

• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves

• Surgeons Like EVAR• Less Invasive• Lower mortality

• Patients Like EVAR• Less Invasive• Lower mortality

• Surgeons Don’t Follow Patients• Costly• Burdensome

• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves

• Surgeons Like EVAR• Less Invasive• Lower mortality

• Patients Like EVAR• Less Invasive• Lower mortality

• Surgeons Don’t Follow Patients• Costly• Burdensome

• EVARs fail over time• 40% at 10 years• No “flattening” of failure curves

Decision Aids • Tools designed to help patients participate in

healthcare decisions

• Provide information on competing options

• Help patients clarify and communicate their values

Decision Aids • Medical Treatments

• Steroids vs. Biologics for Arthritis

• Medical vs. Surgical Treatment• Medical management vs. arthroplasty for degenerative joint

disease

• Surgical Treatments

Decision Aids • Medical Treatments

• Steroids vs. Biologics for Arthritis

• Medical vs. Surgical Treatment• Medical management vs. arthroplasty for degenerative joint

disease

• Surgical Treatments

Decision Aids • Medical Treatments

• Steroids vs. Biologics for Arthritis

• Medical vs. Surgical Treatment• Medical management vs. arthroplasty for degenerative joint

disease

• Surgical Treatments

Options for Abdominal Aortic Aneurysm Repair

Open • Invasive• Longer recovery• Durable

Endovascular • Less invasive• Shorter recovery• Less durable

Study Objective• To implement a decision aid designed to help Veterans choose

between an open and endovascular repair for their AAA.

• To test if the decision aid makes it more likely for Veterans to receive the type of aneurysm repair that is align with their preference.

Study Objective• To implement a decision aid designed to help Veterans choose

between an open and endovascular repair for their AAA.

• To test if the decision aid makes it more likely for Veterans to receive the type of aneurysm repair that is align with their preference.

Veterans with Existing AAA

≥5.0 cmOpen/EVARCandidate

Veterans with Existing AAA

≥5.0 cmOpen/EVARCandidate

Control Sites (10 VA Hospitals):1. Repair Preferences Survey*2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Veterans with

Existing AAA

≥5.0 cm

Open/EVAR

Candidate

Control Sites (10 VA Hospitals):1. Repair Preferences Survey*

2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Intervention Sites (n=10 VA Hospitals):1. Pre-Survey, Decision Aid, Repair Survey*

2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Veterans with

Existing AAA

≥5.0 cm

Open/EVAR

Candidate

Control Sites (10 VA Hospitals):1. Repair Preferences Survey*

2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Intervention Sites (n=10 VA Hospitals):1. Pre-Survey, Decision Aid, Repair Survey*

2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Veterans with

Existing AAA

≥5.0 cm

Open/EVAR

Candidate

Control Sites (10 VA Hospitals):1. Repair Preferences Survey*

2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Intervention Sites (n=10 VA Hospitals):1. Pre-Survey, Decision Aid, Repair Survey*

2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Follow Veterans for Two Years to See What Happens When AAA Repair Occurs

Veterans with Existing AAA

≥5.0 cmOpen/EVARCandidate

Control Sites (10 VA Hospitals):1. Repair Preferences Survey*2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Main Outcome Measure:

Did Preferred AAA Repair Type = Actual Repair Type

Intervention Sites (n=10 VA Hospitals):1. Pre-Survey, Decision Aid, Repair Survey*2. Vascular Surgery Consultation3. Surgeon Survey, Decision Process Score

Follow Veterans for Two Years to See What Happens When AAA Repair Occurs

Overall Study Goals• Identify factors associated with patient preference for open surgical

repair or EVAR for when facing treatment for AAA

• More broadly, help identify the best ways to help Veterans make the best decisions when facing surgery.

Overall Study Goals• Identify factors associated with patient preference for open surgical

repair or EVAR for when facing treatment for AAA

• More broadly, help identify the best ways to help patients make the best decisions when facing surgery.

Participating Sites

Participating Sites

PReferences for Open Versus Endovascular AAARepair Trial (PROVE-AAA)

VA HSR&D

PIs: Goodney, Ayra, Dosuoglu, Raffetto, Henke, Tang, Mureebee, Kougias, Zhou, Johanning, Scali, Stone, Orion,

Spangler, Tzeng, Halpern, Inhat, O’Connell, Brooke, Nelson, and Brewster

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Enrollment Leaderboard

Summary • Patient preferences may play an important role in choosing between

open repair and EVAR.

• Implementing a decision aid to help Veterans choose their type of aneurysm repair in vascular surgery clinics within the VA is achievable and efficient.

• Our future work aims to test, whether the decision aid will improve alignment with Veteran preferences and their treatment.

Summary • Patient preferences may play an important role in choosing between

open repair and EVAR.

• Implementing a decision aid to help Veterans choose their type of aneurysm repair in vascular surgery clinics within the VA is achievable and efficient.

• Our future work aims to test, whether the decision aid will improve alignment with Veteran preferences and their treatment.

Summary • Patient preferences may play an important role in choosing between

open repair and EVAR.

• Implementing a decision aid to help Veterans choose their type of aneurysm repair in vascular surgery clinics within the VA is achievable and efficient.

• Our future work will help us decide if a decision aid will improve alignment with Veteran preferences and their treatment for AAA.

Thank You!