Practical Thoracic Decision Making
When designing this edition of Endovascular Today, we began by asking ourselves, “What questions would we most like to see answered in the thoracic arena?” We wanted to explore not only the latest in technology and new data, but also the clinical scenarios we encounter regularly but lack clearly defined algorithms.
To open our feature on thoracic aortic repair, Nikolaos Tsilimparis, MD, PhD; Fiona Rohlffs, MD; Eike Sebastian Debus, MD, PhD; and Tilo Kölbel, MD, PhD, focus on what we know and what we don’t know about type B dissections. Although the former category increases with each year, many of our patients still fall into the latter. For example, how should the patient with a complicated type B dissection presenting with proximal extension to the left common carotid artery be managed? In the first of two “Ask the Experts” panels in this edition, we pose this question.
Next, Timothy A. Resch, MD, looks at current and future endovascular treatment options for some of our most challenging thoracoabdominal aneurysmal cases. His article describes the technological progress and study results to date, as well as ongoing platform developments that have the potential to improve our capabilities.
Our second “Ask the Experts” session follows, this time posing the question as to whether clinically asymptomatic patients with acute type B dissections and radiographic malperfusion should be treated. Kira N. Long, MD, and Ross Milner, MD, FACS, take a close look at branched stent graft designs currently in various stages of clinical evaluation, detailing the unique elements of each design and summarizing published data where available.
The esteemed group from the Aortic Center at University Hospital of Lille address the utility of fusion imaging for the aortic arch, exploring the possibilities for this modality in assisting endovascular intervention. Next, Christian C. Shults, MD; Frederick Tolle, BS; and Edward Y. Woo, MD, discuss alternative access options that can enable TEVAR patients with seemingly prohibitive or challenging anatomy with a review of current access methods.
Tara M. Mastracci, MD, reviews the etiology, incidence, clinical presentation, and rationale for repair for the aberrant right subclavian arteries. Closing our thoracic feature, Daniel K. Han, MD, RPVI; Christine Jokisch, BS; and James F. McKinsey, MD, discuss the applicability and durability of commonly used extrathoracic debranching techniques in order to expand the landing zone for TEVAR. Despite the success of endovascular options, surgical understanding and capabilities remain critical, particularly in pathologies involving the arch.
Outside of the thoracic arena, Katharine L. Krol, MD, previews the new CPT codes for 2017 along with the changes ahead for interventional CPT in the United States. This month’s featured interview is with Rick de Graaf, MD, PhD. The Maastricht-based interventional radiologist discusses the latest in venous obstruction therapy, imaging and simulation applications, and the modern vascular congress landscape.
We are humbled and grateful for the efforts put forth by our friends and colleagues who have contributed their expertise this month. We hope that you too have learned a bit more about what the near future holds for patients with challenging thoracic pathologies.
Edward Y. Woo, MD
Ian M. Loftus, MD, FRCS
Guest Chief Medical Editors