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Attendees at Tuesday afternoon’s “Topics Related to Open Surgery and Aortic Coarctations” session will learn when open surgery is the best choice despite remarkable advances in endovascular treatment.
“There are still open procedures that every vascular surgeon needs to know how to do well,” said moderator Dr. Fred Weaver of the University of Southern California, Los Angeles.
Coral reef lesions, aortoesophageal fistulas, extensive aortobifemoral occlusions, and celiac axis compression syndromes are often just too complex and extensive for endovascular approaches, and endovascular procedures are less likely to work when patients have underlying problems such as Marfan syndrome and Takayasu arteritis. In addition, open fixes for renal artery disease better preserve kidney function, Dr. Weaver noted. They also make sense for young patients needing a durable, one-time fix. “We don’t have much long-term follow-up experience with endovascular procedures, but we have almost a half-century of experience with open vascular procedures. We know how durable they can be,” he said.
Issues surrounding open procedures and more will be addressed in the session. “Open surgical solutions are oftentimes deferred or not even offered for fear of bad outcomes,” but “they can be successful, and you have to have them in your playbook,” said co-moderator Dr. James Black of Johns Hopkins University.
Three presentations will tackle critical limb ischemia (CLI), a “hot topic that is still very controversial,” Dr. Weaver noted.
Dr. Julien Sfeir of Lebanese University, Beirut, will discuss open salvage after failed endovascular CLI intervention. Dr. R. Clement Darling of Albany Medical College in New York, and also a moderator, will discuss the role of open procedures in the endovascular era, and Dr. Carlo Setacci of the University of Siena, Italy, will address combining open and endovascular techniques for especially difficult cases.
BEST-CLI, an ongoing randomized controlled trial comparing endovascular therapy with open surgical bypass in CLI, will likely be discussed, which is “one of the reasons someone might want to come to this session. Nobody really knows what’s the best option in a lot of situations,” Dr. Weaver said.
Dr. Black will also address when open repair is best – and how to do it – when there’s a distal aortic failure after thoracic endovascular aortic repair (TEVAR). “Stents may palliate dissection in the chest, but dissection beyond the stent into the abdomen remains untreated, and there can life-threatening growth of the aortic diameter. Because the dissection anatomy can be so variable, open surgery is the most expeditious fix, especially in a patient with acute symptoms” he said.
One presentation will buck the theme: a new endovascular approach for aortic coarctation. With the recent approval of the NuMED Cheatham Platinum Stent System, “we now have a viable device solution to handle what otherwise would be a major surgery. It’s a very large diameter, balloon-expandable stent graft with significant radial force made to order for this problem. We’ve totally reversed the treatment paradigm, from 10 days in the hospital and 2 months recovery to 1 night in the hospital and you are driving in 2 days,” Dr. Black said.
Yet “whether it works over the long term is an area of considerable uncertainty. This is an area which is in flux,” Dr. Weaver noted. Dr. Elchanan Bruckheimer will speak about the COAST 1 and 2 trials that preceded the Food and Drug Administration approval of the Cheatham Platinum Stent System.
Session 16:
Topics Related to Open Surgery and Aortic Coarctations
Tuesday, 4:32 p.m. – 5:58 p.m.
Grand Ballroom West, 3rd Floor
Attendees at Tuesday afternoon’s “Topics Related to Open Surgery and Aortic Coarctations” session will learn when open surgery is the best choice despite remarkable advances in endovascular treatment.
“There are still open procedures that every vascular surgeon needs to know how to do well,” said moderator Dr. Fred Weaver of the University of Southern California, Los Angeles.
Coral reef lesions, aortoesophageal fistulas, extensive aortobifemoral occlusions, and celiac axis compression syndromes are often just too complex and extensive for endovascular approaches, and endovascular procedures are less likely to work when patients have underlying problems such as Marfan syndrome and Takayasu arteritis. In addition, open fixes for renal artery disease better preserve kidney function, Dr. Weaver noted. They also make sense for young patients needing a durable, one-time fix. “We don’t have much long-term follow-up experience with endovascular procedures, but we have almost a half-century of experience with open vascular procedures. We know how durable they can be,” he said.
Issues surrounding open procedures and more will be addressed in the session. “Open surgical solutions are oftentimes deferred or not even offered for fear of bad outcomes,” but “they can be successful, and you have to have them in your playbook,” said co-moderator Dr. James Black of Johns Hopkins University.
Three presentations will tackle critical limb ischemia (CLI), a “hot topic that is still very controversial,” Dr. Weaver noted.
Dr. Julien Sfeir of Lebanese University, Beirut, will discuss open salvage after failed endovascular CLI intervention. Dr. R. Clement Darling of Albany Medical College in New York, and also a moderator, will discuss the role of open procedures in the endovascular era, and Dr. Carlo Setacci of the University of Siena, Italy, will address combining open and endovascular techniques for especially difficult cases.
BEST-CLI, an ongoing randomized controlled trial comparing endovascular therapy with open surgical bypass in CLI, will likely be discussed, which is “one of the reasons someone might want to come to this session. Nobody really knows what’s the best option in a lot of situations,” Dr. Weaver said.
Dr. Black will also address when open repair is best – and how to do it – when there’s a distal aortic failure after thoracic endovascular aortic repair (TEVAR). “Stents may palliate dissection in the chest, but dissection beyond the stent into the abdomen remains untreated, and there can life-threatening growth of the aortic diameter. Because the dissection anatomy can be so variable, open surgery is the most expeditious fix, especially in a patient with acute symptoms” he said.
One presentation will buck the theme: a new endovascular approach for aortic coarctation. With the recent approval of the NuMED Cheatham Platinum Stent System, “we now have a viable device solution to handle what otherwise would be a major surgery. It’s a very large diameter, balloon-expandable stent graft with significant radial force made to order for this problem. We’ve totally reversed the treatment paradigm, from 10 days in the hospital and 2 months recovery to 1 night in the hospital and you are driving in 2 days,” Dr. Black said.
Yet “whether it works over the long term is an area of considerable uncertainty. This is an area which is in flux,” Dr. Weaver noted. Dr. Elchanan Bruckheimer will speak about the COAST 1 and 2 trials that preceded the Food and Drug Administration approval of the Cheatham Platinum Stent System.
Session 16:
Topics Related to Open Surgery and Aortic Coarctations
Tuesday, 4:32 p.m. – 5:58 p.m.
Grand Ballroom West, 3rd Floor
Attendees at Tuesday afternoon’s “Topics Related to Open Surgery and Aortic Coarctations” session will learn when open surgery is the best choice despite remarkable advances in endovascular treatment.
“There are still open procedures that every vascular surgeon needs to know how to do well,” said moderator Dr. Fred Weaver of the University of Southern California, Los Angeles.
Coral reef lesions, aortoesophageal fistulas, extensive aortobifemoral occlusions, and celiac axis compression syndromes are often just too complex and extensive for endovascular approaches, and endovascular procedures are less likely to work when patients have underlying problems such as Marfan syndrome and Takayasu arteritis. In addition, open fixes for renal artery disease better preserve kidney function, Dr. Weaver noted. They also make sense for young patients needing a durable, one-time fix. “We don’t have much long-term follow-up experience with endovascular procedures, but we have almost a half-century of experience with open vascular procedures. We know how durable they can be,” he said.
Issues surrounding open procedures and more will be addressed in the session. “Open surgical solutions are oftentimes deferred or not even offered for fear of bad outcomes,” but “they can be successful, and you have to have them in your playbook,” said co-moderator Dr. James Black of Johns Hopkins University.
Three presentations will tackle critical limb ischemia (CLI), a “hot topic that is still very controversial,” Dr. Weaver noted.
Dr. Julien Sfeir of Lebanese University, Beirut, will discuss open salvage after failed endovascular CLI intervention. Dr. R. Clement Darling of Albany Medical College in New York, and also a moderator, will discuss the role of open procedures in the endovascular era, and Dr. Carlo Setacci of the University of Siena, Italy, will address combining open and endovascular techniques for especially difficult cases.
BEST-CLI, an ongoing randomized controlled trial comparing endovascular therapy with open surgical bypass in CLI, will likely be discussed, which is “one of the reasons someone might want to come to this session. Nobody really knows what’s the best option in a lot of situations,” Dr. Weaver said.
Dr. Black will also address when open repair is best – and how to do it – when there’s a distal aortic failure after thoracic endovascular aortic repair (TEVAR). “Stents may palliate dissection in the chest, but dissection beyond the stent into the abdomen remains untreated, and there can life-threatening growth of the aortic diameter. Because the dissection anatomy can be so variable, open surgery is the most expeditious fix, especially in a patient with acute symptoms” he said.
One presentation will buck the theme: a new endovascular approach for aortic coarctation. With the recent approval of the NuMED Cheatham Platinum Stent System, “we now have a viable device solution to handle what otherwise would be a major surgery. It’s a very large diameter, balloon-expandable stent graft with significant radial force made to order for this problem. We’ve totally reversed the treatment paradigm, from 10 days in the hospital and 2 months recovery to 1 night in the hospital and you are driving in 2 days,” Dr. Black said.
Yet “whether it works over the long term is an area of considerable uncertainty. This is an area which is in flux,” Dr. Weaver noted. Dr. Elchanan Bruckheimer will speak about the COAST 1 and 2 trials that preceded the Food and Drug Administration approval of the Cheatham Platinum Stent System.
Session 16:
Topics Related to Open Surgery and Aortic Coarctations
Tuesday, 4:32 p.m. – 5:58 p.m.
Grand Ballroom West, 3rd Floor