SVS von Liebig Forum: Complex Aortic Endografting

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Innovative approaches to minimally invasive repair of the aorta will be featured during Thursday morning’s William J. von Liebig Forum.

Dr. R. Clement Darling III

“This year, the forum’s focus is on complex aortic endografting for a wide variety of aortic diseases, predominantly thoracoabdominal aortic aneurysms and aortic dissections,” said session co-moderator Matthew Eagleton, MD, chief of the division of vascular and endovascular surgery at Massachusetts General Hospital in Boston. “Surgeons who treat aortic disease will learn about new devices and new techniques that they will want to incorporate into their practice. They’ll also learn whether some of the techniques and procedures they are currently employing are still worth doing or may have unforeseen risks. Should they change their practices and approaches to patients with complex aortic disease, or should they continue down the road and recognize that it’s safe for patients?” The session will feature eight abstracts from vascular surgeons in the United States and Europe that will accentuate some of the newer, advanced technology, said session co-moderator R. Clement Darling III, MD, chief of the division of vascular surgery at Albany Medical Center Hospital in New York.

“To minimize the complications of complex aortic aneurysm repair, endovascular technology has to be evaluated, and we need to know what works, what doesn’t, and what are the long-term outcomes,” he said. “These presentations will help us understand the best techniques and the best current and future technology in percutaneous repair of complex aneurysms from the aortic arch down to the abdominal aorta.”

Dr. Matthew Eagleton

The program kicks off with a talk by Emanuel R. Tenorio, MD, PhD, of the Mayo Clinic about a prospective, nonrandomized study to evaluate cone beam computed tomography for technical assessment of standard and complex endovascular aortic repair. In other presentations, Tilo Kölbel, MD, PhD, of the University Heart Center Hamburg in Germany will discuss a single-center experience with a double-branched aortic arch endograft, technology not yet available in the United States. A U.S. national consortium, organized to better assess outcomes for endovascular therapy for complex aortic disease, will discuss their work with target artery outcomes after branched and fenestrated endovascular repair of pararenal and thoracoabdominal aortic aneurysms in the U.S. IDE (investigational device exemption) experience, and a group from Bologna, Italy, will discuss the risk of aneurysm rupture and target visceral vessel occlusion during the lead period of custom-made fenestrated/branched endografts.

Additional talks will go over percutaneous large-bore axillary artery access techniques for complicated EVAR (endovascular aneurysm repair) and current guidelines and indications for repair of abdominal aortic aneurysms.

One concern for much of this new technology is durability, Dr. Darling said. Jason Hurd, MD, of the University of Washington, Seattle, will discuss the long-term durability of a physician-modified endograft.

“We in the U.S. don’t have access to some of the technology that’s available worldwide, and there are physicians out there who do modifications of their own endografts,” Dr. Eagleton said. “This study happens to look at a prospectively maintained database from a physician-sponsored IDE study to specifically look at outcomes with regard to physician modification. The results of this are very important for us to know – is this something we can do for patients [who] need it, or is this something we should just shy away from completely? We don’t know the answer.”

Added Dr. Darling, “This presentation will allow us to see not only the current and future technology to be used but also how well it works over time. We are lucky to be involved in the evolution of minimally invasive technology for the repair of complex aortic pathology.”

Overall, said Dr. Darling, “This forum will outline the advances that have been made and some of the techniques that can be used to treat patients. Continued evaluation of the outcomes, applications and limitations of technology will help us take better care of patients.”

Thursday
8:30 – 10 a.m.
HCC, Ballroom A/B
S1: William J. von Liebig Forum

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