This year’s VEITHsymposium® was filled with presentations on new developments in the treatment of aortic disease from the world’s leading physicians. If you weren’t able to be there, here are our top 10 takeaways from the meeting.
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Don’t skimp on the neck.
Device failure is often caused by an issue with the proximal landing zone. Proper planning is crucial for repairing a short-neck aneurysm effectively the first time. Extending the proximal landing zone means more solid ground to secure the graft.
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Patient selection is key.
Careful patient selection based on the anatomic requirements of a device is critical to the success of EVAR. The goal is to fit the device to the patient, not the patient to the device.
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Intentional staging in cases of extensive TAAA disease could be beneficial.
Staging a procedure in the treatment of extensive thoracoabdominal aneurysmal disease could help protect against spinal cord ischemia by giving the lumbar arteries time to revascularize.
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Adhering to Indications for Use is critical to the durability of EVAR.
Device failures happen largely when a graft is used outside the limits of its IFU. Using a device that is designed for the patient’s anatomy and disease state could help prevent issues like endoleaks.
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Not all bare stents are created equal.
Bare stent design in the thoracic aorta is important, especially in patients with a blunt force traumatic injury (BFTI) such as a transection. Choosing a device with an atraumatic bare stent could help decrease device-related reentry tears and potential for retrograde dissections.
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Pick a good proximal landing zone and durability will follow.
Aortic disease is progressive. To mitigate many of the modes of graft failure over time, choose an adequate healthy aortic landing zone. Many secondary interventions are caused by issues with proximal landing zone, including continued weakening of the aortic wall over time.
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If you can’t help, at least don’t hurt.
When it comes to assessing the treatment risk of open vs. endovascular repair for a thoracoabdominal aortic aneurysm, Dr. Gustavo Oderich told his audience: “Our prime purpose in this life is to help others, and if you can’t help them, at least don’t hurt them.”
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Asymptomatic thoracic aneurysms could be identified by 8 simple markers.
Thoracic aneurysms are often a silent killer. Eight simple identifiers could point to the presence of a TAA including: an intracranial aneurysm, bovine aortic arch, abdominal aortic aneurysm, simple renal cysts, bicuspid aortic valve, family history, the thumb-palm test, and temporal arteritis or other autoimmune disorders.
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Durability is in the details.
Three key device characteristics are important for durability in TEVAR: Low profile and flexibility, safe and easy deployment, and good sealing and conformability.
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New fusion technology can simplify procedures and reduce radiation dose.
Radiation exposure is one of the most controversial topics in EVAR. New fusion technology can facilitate cannulation, reduce fluoroscopy time and reduce radiation dose for both the patient and physician.
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Gustavo Oderich, MD, is a paid consultant of Cook Medical.