JMIR Publications

ABSTRACT

Background:

Endovascular aneurysm repair (EVAR) is the standard treatment for abdominal aortic aneurysm (AAA), but postoperative surveillance remains dependent on intermittent imaging, limiting the ability to detect haemodynamic changes between follow-up appointments. Emerging implantable sensing technologies have the potential to support continuous remote monitoring after EVAR; however, successful implementation depends on understanding the perspectives of both patients and clinicians regarding their clinical value, usability and integration into care pathways.

Objective:

We sought to understand how patients and clinicians perceive implantable digital monitoring technologies for post-EVAR surveillance and to identify stakeholder-informed requirements that could guide the design, implementation and clinical adoption of future digital surveillance systems.

Methods:

Semi-structured interviews were conducted with five patients (a mix of pre-EVAR and post-EVAR surveillance cohorts) and eight clinicians (vascular surgeons, cardiology consultants and radiologists). Interviews were audio-recorded, transcribed verbatim, managed and coded in NVIVO, and analysed using framework analysis. Coded data were summarised in a framework matrix to enable systematic comparison of themes within and across stakeholder groups.

Results:

Framework analysis generated four patient themes and six clinician themes, which were charted against five pre-specified implementation domains (clinical validity, workflow integration, usability, adoption feasibility and behavioural engagement). Patients and clinicians appeared to diverge systematically: patients valued monitoring chiefly as psychological reassurance, whereas clinicians prioritised diagnostic reliability, defined triage responsibility and prospective validation before adoption. Two findings were specific to this cohort. First, priorities differed between pre-EVAR and post-EVAR patients: pre-EVAR patients framed the device through anxiety about rupture, whereas post-EVAR patients were preoccupied with persistent post-surgical symptoms rather than the technology itself. Second, clinicians identified that daily symptom logging is confounded in the post-EVAR population, because leg and abdominal pain are expected sequelae of the procedure rather than markers of aneurysm sac behaviour, making self-reported symptoms an unreliable proxy for complications.

Conclusions:

In this study, the adoption of implantable digital monitoring technologies following EVAR emerged as being contingent on implementation strategies that separately address patients' need for reassurance and clinicians' need for diagnostic validity and manageable workload. Distinguishing technological from clinical sources of patient difficulty, particularly between pre- and post-EVAR cohorts, and linking device adherence to broader adherence behaviour, offers a more grounded basis for the next phase of development. These findings provide stakeholder-informed design and implementation considerations for future digital surveillance technologies in vascular care and highlight the importance of aligning technical innovation with clinical practice and user needs.