Advances and Perspectives in Vascular Surgery and Endovascular Therapy
Ibrahim Akin, Stephan Kische and Hüseyin Ince
from the Department of Medicine, Divisions of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, Germany
Correspondence:
Hüseyin Ince MD, PhD
Department of Medicine
Division of Cardiology
University Hospital Rostock
Rostock School of Medicine
Ernst-Heydemann-Str. 6
18057 Rostock, Germany
E-Mail:
Tel.: +49 (0)381 494 77 97
Fax: +49 (0)381 494 77 98
Diseases of the thoracic aorta remain among the most lethal and difficult to treat conditions. Endovascular repair of thoracic aortic pathology is emerging as the preferred treatment strategy in certain patients, as increasing data suggest that endovascular repair may be performed with lower peri-operative morbidity and mortality rates and similar midterm survival, when compared with standard open repair. However, because of anatomic constraints related to required endograft seal zones, a significant number of patients are excluded from standard endovascular repair. Hybrid techniques, including open aortic arch and thoracoabdominal debranching procedures, have been described to allow creation of proximal and/or distal landing zones for the stent graft seal. Hybrid techniques may be performed with lower rates of morbidity and mortality than conventional open repair, and they appear to be a safe alternative to open repair for thoracoabdominal and aortic arch aneurysms in properly selected patients with significant comorbidity or prior open aortic surgery. My talk will touch considerations relevant to thoracic endografting, with an emphasis on hybrid procedures used to treat more complex thoracic aortic pathology.
The second part of my talk will focus on advances in aortic stenosis. With improved life expectancy, the incidence of aortic stenosis is rising. However, up to one-third of patients who require lifesaving surgical aortic valve replacement are denied surgery due to a high operative mortality rate. Such patients can only be treated with medical therapy or percutaneous aortic valvuloplasty, neither of which has been shown to improve mortality. With advances in interventional cardiology, transcatheter methods have been developed for aortic valve replacement. Clinical trials are investigating these devices in patients with severe aortic stenosis that have been denied surgery. Preliminary results from these trials suggest that transcatheter aortic valve replacement is not only feasible, but an effective way to improve symptoms. My talk will describe the current technology and display available outcome data.