Vascular Intervention - Alternatives to Surgery
Majdi Aschi, DO, FACC, FCCP,
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| Today, endovascular therapy is commonly used in the management of a growing array of vascular lesions and
conditions traditionally treated by conventional surgery. Historically, vascular surgeons were reluctant to recognize the potential
of endoluminal therapy; however the recent development in catheter-based technology, particularly the endovascular
grafting should prove sufficiently enticing to convince all but the most stalwart surgeons that they can no longer turn a blind eye to
the endovascular revolution. Most vascular surgery training centers have recognized this dilemma and have started
incorporating endovascular therapy training into their programs. Although surgeons have played a role in the development of
endovascular techniques, pioneering cardiologists and radiologists, such as Gruntzig and Dotter are rightly credited with ushering in the
era of endovascular therapy. Today, interventional cardiologists and radiologists are teaming up and working side by side
with vascular surgeons to deliver the better of two worlds to their patients. It is not uncommon to see a patient receiving a
"hybrid" procedure where he/she receives both endovascular therapy and traditional surgery to a certain vascular condition.
Endovascular concepts and techniques are reshaping treatment. The potential for, low morbidity solutions to very complex clinical problems are a common goal among vascular specialists. Guidewires, catheters, balloons and stents are forming the technical and conceptual basis for endovascular intervention. Although many endovascular procedures ultimately may not be clinically useful, they have the potential to dramatically change the spectrum of vascular practice. The arteriographic schism currently existing represents an arbitrary division of labor and knowledge between vascular specialists and technicians, which invites discontinuity in our patient care. To carry this into the future would be a major setback in the development of endovascular therapy. The preoccupation with defining and categorizing procedures on the basis of percutaneous versus traditional surgery is very counterproductive. The focus should be on making smaller incisions and safer interventions. Lack of familiarity with the variety of approaches encourages advocates of a specific technique to crusade for applying exclusively that technique, regardless of whether it is open or endoluminal operation. Most of these gaps in endovascular therapy would be eliminated or narrowed significantly with better clinical orientation for clinicians and technicians. This issue of Jacksonville Medicine offers an excellent flavor of review articles by a variety of excellent vascular specialists (cardiologist, radiologists and vascular surgeons) involved in cutting edge endovascular therapy. All have dedicated their time and efforts to the spirit of teamwork and to bringing our patients and us the better of two worlds. It is my opinion that endoluminal graft stenting of aneurysms, carotid angioplasty/stenting, renal artery angioplasty/stenting and others are here to stay. Time, experience, randomized trials; advances in technology will shape the future of vascular intervention. Jacksonville Medicine / December, 2000
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