• Alessandra Pia Porretta, Mario Alerci, Rolf Wyttenbach, Francesco Antonucci, Mattia Cattaneo, Marcel Bogen, Marco Toderi, Adriano Guerra, Fabio Sartori, Marcello Di Valentino, Paolo Tutta, Costanzo Limoni, Augusto Gallino, and Ludwig K von Segesser.
• 1 Division of Cardiology and Vascular Medicine, Department of Internal Medicine, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland.
• J. Endovasc. Ther. 2017 Dec 1; 24 (6): 852-858.

PurposeTo 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.MethodsA 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.ResultsNo 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.ConclusionThe 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.

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