Expanding the Role of Peripheral Endografts
The February issue of Endovascular Today includes updates on a variety of key topics, such as the latest information on peripheral endograft applications, a detailed look at the recently released and controversial CAS trial data, and our annual vascular closure update.
Much has been written about the use of endografts for pathology in the abdominal and thoracic aorta, but there are expanding applications for these devices in the peripheral circulation. Not only can they be used to treat aneurysms, pseudoaneurysms, and perforations, but there is increasing interest in the use of endografts for the primary treatment of atherosclerotic disease and even for the treatment of in-stent restenosis. Our cover feature opens with an article from Mark W. Mewissen, MD, who discusses endograft treatment in the SFA using the Viabahn, and anticipates that the VIBRANT trial will provide an opportunity to better understand the natural history of this treatment strategy for the SFA and supply much-needed comparative data with bare nitinol stents. Leonardo C. Clavijo, MD, PhD, and myself follow with a series of case studies detailing experiences with balloon-expandable, PTFE-covered stents in patients with complex aortoiliac disease, complex plaque composition, and recurrent in-stent restenosis. Our colleague David L. Dawson, MD, reviews the application of covered stents in the carotid arteries. He reminds us that no commercially available covered stent is FDA-approved for carotid artery applications, and that there are no long-term data reported on their durability. Gary M. Ansel, MD, and coauthors explore using Viabahn covered stents and adjunctive therapies to treat restenosis in the SFA, which appears to be a promising approach to this important and difficult-to-treat clinical problem. Robert J. Rosen, MD, and Richard M. Green, MD, discuss hypogastric artery embolization and endografting, an adjunctive technique in performing endovascular aneurysm repair, and delve into the controversies and techniques involved with endoleak treatment and prevention. Mouhamad O. Annous, MD, and Srilatha Kanumuru, MD, discuss using the Viabahn endograft to treat pseudoaneurysm and venous outflow stenosis, another interesting application of covered stent technology. John Paul Runyon, MD, finishes with an interesting case highlighting the combination therapy of plaque excision and stent graft deployment using the SilverHawk and the Viabahn.
Two subfeatures highlight this issue. Zoltan Turi, MD, provides his annual update on the latest in vascular closure devices. We also feature several perspectives from thought leaders regarding the data from the EVA-3S, SPACE, and SAPPHIRE trials, as well as recent registry data. Drs. Alain Branchereau, Jacques Busquet, Mark Wholey, Sumaira Macdonald, Richard Green, and William Gray discuss what can be learned from these trials and their effect on the practice of carotid stenting in the coming years.
A case report provided by Michael Wholey, MD, and William Wu, MD, illustrates how endovascular techniques can be the first line of therapy for visceral artery aneurysms. Robert G. Whirley, PhD; Matthew S. Waninger, PhD; and Roy K. Greenberg, MD, present the endovascular graft discussions from the Cleveland Clinic Stent Summit, held in late August 2006. In their Techniques article, Shahriar Moossavi, MD, PhD; and John R. Ross, MD describe endovascular sutureless venous anastomosis using the Viabahn to create an upper-arm AVG in a patient with previously failed upper-arm arteriovenous access. Finally, we are pleased to provide a featured interview with Zvonimir Krajcer, MD, a pioneer in percutaneous AAA repair.
As you can see, this issue is packed with a lot of great stuff. We hope that you find it to be helpful, insightful, and informative. Grab a glass of wine, pull the chair next to the fire, and enjoy!