116. Delphi: The Global Consensus That's Changing How No-Option Patients Are Treated

In this episode of Life of Flow, we sit down with Dr. Mario Alejandro Fabiani to explore a question that directly impacts clinical decision-making: what does a “no option” patient mean?From that starting point, Dr. Fabiani leads an international consensus aimed at bringing structure to a definition that currently varies depending on the physician, their experience, and their clinical context. The conversation also highlights how patient profiles have shifted over time, why commonly cited percentages may not reflect today’s reality, and how these assumptions influence decisions such as attempting revascularization or proceeding with amputation. Toward the end, the focus turns to the need to validate and adopt this consensus in real-world practice.03:32 From critique to action: building evidence04:00 Forming an international Delphi consensus05:09 What a Delphi is and how it works08:51 Why the “no option” definition needs to change12:23 The debate around the 15% “no option” figure14:51 How patient profiles have changed over time17:26 Geographic variation in cases and decision-making20:22 Presentation of the Delphi consensus39:53 Real-world amputation outcomes in Latin AmericaWho Should ListenVascular surgeons, trainees, and clinicians managing complex patients who want to better understand how the definition of “no option” impacts real-world decision-making.About Dr. Mario Alejandro FabianiDr. Mario Alejandro Fabiani is a physician trained at the National University of La Plata (Argentina). He completed his residency in General Surgery and served as Chief Resident at CEMIC in Buenos Aires. He then pursued a second specialty in Vascular Surgery and Transplant through a joint program between CEMIC and the Hospital de Clínicas at the University of Buenos Aires. He received scholarships from the Bunge y Born Foundation to attend Yale University and from the Argentine Association of Angiology to train at the Vascular Surgery Service at NYU Medical Center.He later joined the Vascular Surgery and Transplant Service at CEMIC, where he was involved in teaching until 2013. Since then, he has been a full-time professor at Tecnológico de Monterrey. He is Director of the Vascular Medicine Center at Sociedad Académica Temperantia, has participated in hundreds of national and international conferences, pioneered endovascular techniques, and trained dozens of specialists.He is an honorary professor at the University of Valladolid, an honorary member of medical societies in Colombia and Ecuador, and a Level I member of Mexico’s National System of Researchers. With over 25 years of experience, he is one of the most experienced specialists in Mexico in the management of aortic, carotid, and peripheral arterial disease.This episode references the international consensus led by Dr. Fabiani to redefine the “no option” patient. You can access the full document here: academic.oup.com/bjs/advance-article-abstract/doi/10.1093/bjs/znag040/8606833Connect with Dr. Mario Alejandro Fabiani💼 LinkedIn: Mario Alejandro Fabiani🔗 Website: drfabiani.comFollow Life of Flow📲 Instagram: ⁠⁠⁠⁠@LifeofFlowPodcast⁠⁠⁠⁠👍 Facebook: ⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠💼 LinkedIn: ⁠⁠⁠⁠Life of Flow Podcast⁠⁠⁠⁠🐦 X: ⁠⁠⁠⁠@VascularPodcastIf this conversation changed how you think about what it really means for a patient to be “no option,” the decisions made before recommending amputation, and the importance of questioning long-held assumptions in clinical practice, share it with a colleague who would benefit from it. A quick review also helps more physicians and interventionists discover conversations like this.