E-vita open plus for treating complex aneurysms and dissections of the thoracic aorta: a NICE medical technology guidance

The frozen elephant trunk: an overview of hybrid prostheses

INTRODUCTION

Thoracic aortic pathologies implicating the aortic arch and the descending thoracic aorta (DTA) are primarily managed with total aortic arch replacement (TAR). This can be performed as a single-procedure hybrid fashion using the frozen elephant trunk technique (FET), which utilizes hybrid prosthesis. Nevertheless, FET presents certain challenges such as distal stent graft-induced new entry (dSINE), negative aortic remodeling, and reintervention.

AREAS COVERED

The narrative review provides an overview of the four majors FET prosthesis, highlighting their design features, mechanical properties, configurations, and variants, and evaluating their clinical outcomes reported in the literature. The leading prosthesises were compared through their mortality and survival rates, neurological outcomes, dSINE, aortic remodeling, and reintervention rates.

EXPERT OPINION

Four FET devices can be considered the main option on the global market; Thoraflex, E-Vita, Cronus, and Frozenix J Graft. Each hybrid prosthesis (HP) features unique design characteristics, resulting in varying clinical outcomes. Thoraflex and E-Vita are the most widely used and investigated HPs, whilst the use of Cronus and Frozenix is geographically confined to mainly manufacturers' countries. The rates of early mortality, stroke, SCI, dSINE, and reintervention rates were found to be comparable among the four devices, yet, Thoraflex seemed to offer the most optimal clinical profile.

SecurAcath for Securing Peripherally Inserted Central Catheters: A NICE Medical Technology Guidance

Central venous catheters are commonly used to deliver therapies and to monitor patients, and require securing at the point of percutaneous entry to avoid dislodgement. SecurAcath is a catheter securement device designed for central venous catheters. The National Institute for Health and Care Excellence, as a part of its Medical Technologies Evaluation Programme, selected this device for evaluation and invited the manufacturer, Interrad Medical, to submit clinical and economic evidence. The King's Technology Evaluation Centre, an External Assessment Centre commissioned by the National Institute for Health and Care Excellence, independently critiqued the manufacturer's submissions. The External Assessment Centre found a lack of evidence comparing SecurAcath with alternative approaches to securement (StatLock, suturing, tape securement), with one unpublished randomised controlled trial providing the strongest evidence. The External Assessment Centre conducted a new systematic review and meta-analysis and concluded that there is some evidence indicating the non-inferiority of SecurAcath compared to StatLock. The External Assessment Centre considered the manufacturer's economic model to be appropriate but made revisions to some parameters and noted significant heterogeneity in the included studies. The revised model indicated that StatLock was more cost effective than SecurAcath for catheter indwell times of up to 5 days; however, for medium- and long-term indwell times, SecurAcath was the most cost-effective option. The National Institute for Health and Care Excellence Medical Technologies Guidance MTG 34, issued in June 2017, recommended the adoption of SecurAcath for securing peripherally inserted central catheters within the National Health Service in England.

The geko™ electro-stimulation device for venous thromboembolism prophylaxis: a NICE medical technology guidance

The geko™ device is a single-use, battery-powered, neuromuscular electrostimulation device that aims to reduce the risk of venous thromboembolism (VTE). The National Institute for Health and Care Excellence (NICE) selected the geko™ device for evaluation, and invited the manufacturer, Firstkind Ltd, to submit clinical and economic evidence. King's Technology Evaluation Centre, an External Assessment Centre (EAC) commissioned by the NICE, independently assessed the evidence submitted. The sponsor submitted evidence related to the geko™ device and, in addition, included studies of other related devices as further clinical evidence to support a link between increased blood flow and VTE prophylaxis. The EAC assessed this evidence, conducted its own systematic review and concluded that there is currently limited direct evidence that geko™ prevents VTE. The sponsor's cost model is based on the assumption that patients with an underlying VTE risk and subsequently treated with geko™ will experience a reduction in their baseline risk. The EAC assessed this cost model but questioned the validity of some model assumptions. Using the EACs revised cost model, the cost savings for geko™ prophylaxis against a 'no prophylaxis' strategy were estimated as £197 per patient. Following a second public consultation, taking into account a change in the original draft recommendations, the NICE medical technologies guidance MTG19 was issued in June 2014. This recommended the adoption of the geko™ for use in people with a high risk of VTE and when other mechanical/pharmacological methods of prophylaxis are impractical or contraindicated in selected patients within the National Health Service in England.