Advertisement
Advertisement
February 29, 2012
Clinical Impact of Repositionable EVAR Delivery
PANEL
Barry T. Katzen, MD, is Medical Director, Baptist Cardiac & Vascular Institute, in Miami, Florida. He has disclosed that he is a paid consultant to Gore & Associates, Medtronic, Inc., and Boston Scientific Corporation. Dr. Katzen may be reached at barryk@baptisthealth.net.
Brian G. Peterson, MD, FACS, is Associate Professor of Surgery, Division of Vascular Surgery, at Saint Louis University in St. Louis, Missouri. He has disclosed that he is a paid consultant to Gore & Associates. Dr. Peterson may be reached at (314) 577-8310; bpeters1@slu.edu.
Gustavo Paludetto, MD, is Head of Endovascular and Interventional Radiology, Heart Institute in Brasilia, DF, Brazil. He has disclosed that he has no financial interests related to this article. Dr. Paludetto may be reached at (+55) 61 81260777; drgustavo.endovascular@gmail.com.
Jean-Pierre Becquemin, MD, is Professor of Vascular Surgery at Henri Mondor Hospital in Créteil, France. He has disclosed that he is a paid consultant to Gore & Associates, Medtronic, Inc., and Cook Medical. Dr. Becquemin may be reached at jpbecquemin@hotmail.com.
Paul Bachoo, MBChB, FRCS, MSc, is Consultant Vascular Surgeon, Aberdeen Royal Infirmary in Aberdeen, United Kingdom. He has disclosed that he has no financial interests related to this article. Dr. Bachoo may be reached at paulbachoo@nhs.net.
A slow or controlled deployment technique has been described in regard to both the GORE® SIM-PUL Delivery System's (Gore & Associates, Flagstaff, AZ) deployment and many competitors' deployment systems. How does repositioning differ between these options?
Dr. Katzen: Repositioning is really very different than the slow deployment systems and techniques that many operators employ. The GORE® C3 Delivery System's (Gore & Associates) ability to reconstrain the proximal part of the implant makes this device a game-changer. In fact, I don't see the two techniques as being directly related. Many operators use slow deployment as a way to get a more predictable location of the implant. But the reconstrainable or repositionable device is really orders of magnitude better.
Dr. Peterson: Even with slow deployment, the orientation or how a device opens up and behaves within the aorta is somewhat unpredictable. Repositioning offers a much more reliable and accurate deployment option, especially when dealing with angulated proximal necks.
Dr. Paludetto: With the competitors' systems we can only move the device before fully opening the proximal part (the first covered stent). Sometimes, after the device is opened, it does not accommodate to the anatomy as we had wished. The big difference is that the GORE® C3 Delivery System's deployment is the only one that makes it possible to fully open the device at the proximal neck in order to see how the device will be accommodated in the aortic wall. If the device won't accommodate as planned, we can close the proximal part and push up, pull down, and/or rotate the device to achieve the optimal position.
Dr. Becquemin: I would add that the ability to reposition gives a feeling of safety and is a great improvement.
How would you describe the transition or learning curve in adopting the GORE® C3 Delivery System for you, your partners, and trainees?
Dr. Katzen: Even if you've never used a GORE® EXCLUDER® Device (Gore & Associates) before, the GORE® C3 Delivery System is extremely simple to use. If you have used it before, I think you'll be very appreciative of the retained simplicity and the control the handle provides.
Dr. Peterson: Exactly. A lot of physicians really were attracted to the GORE® EXCLUDER® Device because of its simplicity. One concern with this new delivery was that the simplicity would be lost, but it certainly isn't. It's the same turn-and-pull motion, but now it's in triplicate, with the added benefit of being able to reposition if you don't like the initial device positioning.
The transition hasn't been an issue for me or for our general surgery residents and vascular fellows. In fact, using the new repositionable delivery system seems to increase some physicians' confidence in being aggressive, and therefore more accurate, on initial deployment.
Learning any new stent graft system seems intimidating at first. Once you get your hands on this device, however, it becomes evident that there is a very small learning curve needed to adapt to the new delivery system.
Advertisement
Advertisement
