Open Surgery Will Always Have a Role in Complex Aortic Repair - Concepts in Vascular ... · 2019....
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Gordon K. Stokes, MD April 28,2018 Open Surgery Will Always Have a Role in Complex Aortic Repair
Transcript of Open Surgery Will Always Have a Role in Complex Aortic Repair - Concepts in Vascular ... · 2019....
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Gordon K. Stokes, MD
April 28,2018
Open Surgery Will Always
Have a Role in Complex Aortic Repair
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Ebers Papyrus, 2000 BC
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Antyllus The True Father of Vascular Surgery
Antyllus method
proximal and distal ligation
central incision of aneurysm
Thrombus evacuation
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Sir Astley Cooper 1817
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Sir Astley Cooper 1817
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Aneurysm Treatment Fails
Moore 1864 at Middlesex Hospital wired an aneurysm with 26 yards of coils
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Aneurysm Treatment Fails
Carrodi 1879 in Pavia attached the wires to a battery to induce thrombosis
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Rudolph Matas 1923
First successful Aortic ligation
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Endoaneuryrsmorraphy
Obliterative
Restorative
Reconstructive
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Rudolph Nissen, M.D. 1948
Aortic Aneurysm wrapped with polyethene cellophane,1949
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Charles Dubost 1951
First successful homograft replacement of Aortic Aneurysm
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Southern Surgical Association Meeting 1952
Blakemore in New York
rubber band wrapped polythene film insertion of wire then
100 volts of electric current
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Southern Surgical Association Meeting 1952
Blakemore in New York
rubber band wrapped polythene film insertion of wire then
100 volts of electric current
DeBakey
Two successful Homograft cases
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Michael DeBakey, M.D.
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Oscar Creech, Jr., M.D.
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Juan Parody 1990
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Jean Panneton, M.D.
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Jean Panneton, M.D.
“EVAR is a failed experiment”
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Jean Panneton, M.D.
“EVAR has the most failure modes of all procedures.”
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Modes of EVAR Failure
• Endoleak
• Endotension with no demonstrable leak
• Sac growth
• Migration
• Neck dilatation
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Modes of EVAR Failure, continued
• Graft limb Occlusion
• Infection
• Stent Fracture
• Renal Artery Occlusion
• Pelvic Ischemia
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Endoleaks
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Multiple sites for Endoleaks
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Rao et. al., JVS 2015
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Conclusions
FEVAR
Higher rate of progression to renal impairment
Greater rate of secondary interventions
Lower long term survival
Rao et. al., JVS 2015
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Conclusion
Rao et. al., JVS 2015
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Schermerhorn et. At., NEJM, 2015
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Schermerhorn et. At., NEJM, 2015
Endovascular Open
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What is Success?
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Definition of Success
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What is Success?
• Safe
• Effective
• Durable
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Success
• Safe
• Effective
• Durable
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“The good physician treats the disease: the great
physician treats the patient who has the disease.”
Sir William Osler
