Long-term Outcomes of a Telementoring Program for Distant Teaching of Endovascular Aneurysm Repair

J Endovasc Ther. 2017 Dec;24(6):852-858. doi: 10.1177/1526602817730841. Epub 2017 Sep 11.


Purpose: To prospectively evaluate the long-term outcomes after a telementoring program for distant teaching of endovascular aneurysm repair (EVAR) and the degree of EVAR procedure assimilation into routine practice.

Methods: A telementoring protocol using stepwise introduction of EVAR was implemented between a university care center and a remote vascular health care site; from March 1999 to October 2003, 49 EVAR patients (mean age 72 years; 48 men) were treated during telementoring at the remote center. After the telementoring period, 86 patients (mean age 71 years; 77 men) underwent EVAR procedures carried out at the secondary care center from November 2003 to July 2011. The long-term outcomes were compared between the EVAR procedures performed during telementoring with the procedures performed independently thereafter.

Results: No significant difference was appreciated between telementored and not telementored procedures either in 30-day mortality (4.1% vs 2.3%, p=0.621) or in the initial technical success (93.9% vs 97.7%, p=0.353). The telementored group showed no significant difference in overall aneurysm-related mortality (6.1% vs 2.3%, p=0.353) or in the overall complication rates (p=0.985). The reintervention rate was significantly lower among the unmentored procedures (11.6% vs 32.7%, p=0.004). In particular, significantly fewer patients underwent late endovascular procedures (1.2% vs 12.2%, p=0.009) and late percutaneous interventions (7.0% vs 20.4%, p=0.027) after telementoring ceased.

Conclusion: The telementoring program followed here allowed excellent EVAR skill assimilation into the routine practice of a remote health care site. Telementoring is a feasible strategy to support skill introduction in remote medical facilities.

Keywords: abdominal aortic aneurysm; distant teaching; endovascular aneurysm repair; remote teaching; telementoring.

MeSH terms

  • Aged
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortography / methods
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / education*
  • Blood Vessel Prosthesis Implantation / mortality
  • Clinical Competence
  • Computed Tomography Angiography
  • Computer-Assisted Instruction / methods*
  • Curriculum
  • Education, Distance / methods*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / education*
  • Endovascular Procedures / mortality
  • Female
  • Humans
  • Male
  • Mentors*
  • Postoperative Complications / mortality
  • Postoperative Complications / surgery
  • Program Evaluation
  • Prospective Studies
  • Reoperation
  • Risk Factors
  • Telemedicine / methods*
  • Time Factors
  • Treatment Outcome