PLoS One. 2026 Aug 4;21(8):e0355214. doi: 10.1371/journal.pone.0355214. eCollection 2026.
ABSTRACT
Device sales representatives (DSRs) play a key role in providing vascular surgeons with device-specific education, operational guidance, and troubleshooting support. However, industry relationships may introduce bias, raising ethical concerns. This study aimed to evaluate the clinical benefit of DSR presence in the operating room (OR) during standard, infrarenal endovascular aortic repair (EVAR). A retrospective, case-control study was conducted to assess the association between DSR presence and surgical outcomes in elective, infrarenal EVAR cases at an experienced endovascular institution. Preoperative (age, gender, ASA classification, and past medical history), perioperative (device company, OR and fluoroscopy time, and use of additional endografts or stents) and postoperative (length of hospital stay post-operation, endoleaks at six weeks and six months, and mortality at six months) variables were collected for cases between June 1st, 2019 to December 31st, 2022. Fisher's exact test, chi-squared test and student's t-test were used to compare DSR-present and control groups. Ninety standard infrarenal EVARs were included with a DSR present in 64 (71.1%) cases. Cook and Gore devices were used in roughly equal proportions with a single case using a Medtronic device. DSR presence was not associated with a statistically significant change in operative duration (p = 0.53) or fluoroscopy time (p = 0.95), or in rates of endograft usage (p = 0.35) or adjunctive stent use (p = 1.00). Length of hospital stay (p = 0.46), short- (p = 0.63) and long-term (p = 1.00) endoleaks, and mortality rates (p = 1.00) were similar between groups. In this study of standard, infrarenal EVAR procedures at a high volume endovascular centre, DSR presence was not associated with statistically significant differences in case efficiency, device utilization or clinical outcomes. These findings suggest that routine DSR involvement in such procedures may not provide a clear clinical advantage. In light of important ethical considerations, the study calls for a more selective use of DSR support and for larger, multicentre studies to better understand their role in EVAR cases.
PMID:42550851 | DOI:10.1371/journal.pone.0355214