Shipra Arya is Local PI of Study to Empower Veterans' Decision Making for Treatment of Abdominal Aortic Aneurysms
Shipra Arya, MD, Emory vascular surgeon and director of the vascular lab and endovascular surgery at the Atlanta VA Medical Center, is the local site investigator for a national randomized trial that is working to better understand veterans' preferences for treatment of abdominal aortic aneurysms (AAA). In the process, the study plans to promote shared-decision making between vascular surgeons and their patients.
The $1.1M study, "Preferences for Open Vs Endovascular Repair of Abdominal Aortic Aneurysm," or PROVE-AAA, is funded by the Health Services Research and Development branch of the U.S. Department of Veterans Affairs. The study is being led by Philip P. Goodney, MD, of the White River Junction VA Medical Center in Vermont, with whom Dr. Arya has coauthored numerous publications. Dr. Goodney also served as Dr. Arya's mentor for her 2014 Surgical Outcomes Club Research Fellowship.
Five thousand veterans undergo AAA repair each year in VA hospitals. Until recently, most aneurysms were repaired with open surgical treatment — a major surgery requiring two-to-three months of recovery. However, many surgeons now prefer endovascular AAA repair, or EVAR, because the procedure is less risky and patients recover faster, though EVAR has a higher risk of complications, is less durable, and requires regular follow-up with CAT scans. One in five patients treated with EVAR will need a repeat procedure within four years.
Given these trade-offs, the PROVE-AAA team believes that veterans' individual preferences for repair type is essential to choosing either EVAR or the open method. "We suspect that EVAR will be chosen by veterans concerned about pain or disability, while those more focused on durability will want open repair," says Dr. Arya.
A team of 20 vascular surgeons at VA medical centers across the country will conduct the study. At the Atlanta VA, Dr. Arya will enroll 12 veterans who are facing surgery for AAA. Ultimately, 240 veterans will be enrolled nationwide. The study teams will use surveys to determine which factors are associated with veterans' treatment preference, and whether a decision aid improves veterans' satisfaction with care. Findings will be reported to the National Surgery Office Vascular Surgery Advisory Board to help ensure veterans' preferences remain at the center of AAA treatment decisions.