We are delighted to have the opportunity to explore the most recent developments in thoracic endovascular aortic repair (TEVAR) in this edition of Endovascular Today. In 2019 and beyond, the discussion as to TEVAR’s applicability comes down to a variety of factors, ranging from the patient’s unique condition and anatomy to the capabilities of the operator, facility, and selected technology. Optimizing care is about properly assessing all of these components—and staying current on the latest developments in those capabilities. We’ve asked a team of experienced voices to help us with the latter: keeping up to date.

We begin with an outline for the foundational steps needed to successfully create a complex thoracic aortic service by Niamh Hynes, MB BCh BAO, and Tara M. Mastracci, MD. Next, in the first of two expert panel features, we ask William J. Quinones-Baldrich, MD; Eric L.G. Verhoeven, MD; Dr. Woo; Chandler A. Long, MD; Cynthia K. Shortell, MD; Wei Zhou, MD; Joshua Leon Black, BS; Wei Guo, MD; and Cherrie Abraham, MD: does early TEVAR prevent aneurysmal degeneration?

Then, Anahita Dua, MD, and Matthew J. Eagleton, MD, explain how nonionizing radiation imaging technologies have revolutionized endovascular aneurysm repair (EVAR). We also look into potential applications for off-the-shelf devices for thoracoabdominal aortic aneurysms (TAAAs). First, Mark A. Farber, MD, and Federico E. Parodi, MD, describe four new branched and fenestrated grafts undergoing evaluation for TAAA repair. Then, Katherine Stenson, MD; Jorg de Bruin, PhD; Peter Holt, PhD; and Prof. Loftus describe the chimney endovascular aneurysm sealing (ChEVAS) technique.

Our second expert panel discussion comprises Ali Azizzadeh, MD; Audra A. Duncan, MD; Prof. Loftus; Joseph Lombardi, MD; and Germano Melissano, MD, as they provide insight on their strategies for type B aortic dissection. Then, Gustavo S. Oderich, MD, and Emanuel R. Tenorio, MD, evaluate the factors affecting renal function and steps to minimize the risk of renal injury for patients with chronic kidney disease undergoing EVAR. Konstantinos Spanos, MD, and Tilo Kölbel, MD, follow with a discussion on the technologic advancements for lowering the risk of cerebral injury and stroke after TEVAR. Rounding out our TEVAR coverage, Dr. Fatima highlights the surgical approach for repair of aberrant subclavian artery and symptomatic Kommerell diverticulum.

Also in this issue, we have several articles dedicated to transradial access (TRA) across various pathologies. First, Stephanie H. Chen, MD, and Eric C. Peterson, MD, provide tips for navigating the learning curve to gain proficiency in transradial neurointervention. Then, Kamil Arif, MD; Andrew J. Gunn, MD; and Keith J. Pereira, MD, examine the growth of TRA for embolization procedures, along with technical tips for success. Finally, Rahul S. Patel, MD; Aaron Fischman, MD; and Rami Tadros, MD, focus on the TRA approach in lower extremity interventions.

We would also like to thank Adhir Shroff, MD, for his guidance and feedback as a Guest Editor for each of the articles in our TRA subfeature. His expertise in this field is widely renowned, and his assistance in this issue has been invaluable.

Elsewhere, we speak with current Society for NeuroInterventional Surgery President, Richard P. Klucznik, MD, about what’s next in stroke and cerebral aneurysm care. Finally, we conclude our issue with an interview with Gregory Makris, MD, who discusses his role with the CIRSE European Trainee Forum and more.

We hope you find this broad spectrum of content applicable to the questions you face in your own practice, and we look forward to your feedback.

Javairiah Fatima, MD, FACS, FSVS
Ian M. Loftus, MD, FRCS

Edward Y. Woo, MD
Guest Chief Medical Editors