Frank J Criado MD FACS FSVM

A little over a year has passed since the CREST trial results were first announced (in February 2010). A great deal of information has been presented and published since then, and it would be most appropriate to acknowledge that this was a landmark trial. Some experts have gone as far as advancing the label of “the essence of evidence-based medicine” to describe its unique and history-making nature. | Read More

Consider the following: – Renal artery stenosis (RAS) is a frequent finding on patients with severe atherosclerotic disease; – RAS is well documented to be an important treatable cause of severe hypertension; - It can also lead to significant or even critical renal dysfunction when the entire renal-parenchyma mass is affected, most typically in the setting of severe bilateral RAS; - Other potential but less common complications of RAS are well known as well, particularly cardiac dysfunction leading to flash pulmonary edema and aggravated angina symptoms; - Renal artery revascul | Read More

The following statement might be descriptive of an emerging view on endovascular technologies: “Mechanical solutions – bio-mechanics – have propelled vascular surgery and endovascular interventions to new levels of achievement. And they have proved transformational in every way. The ‘aortic space’ is perhaps one of the best examples as endograft repair appears poised to replace standard open surgery. But the flame may be extinguishing itself as purely mechanical developments reach their limit… Many experts would predict that the dominant technologies of tomorrow and beyond will e | Read More

The new age of aortic surgery is one of minimally-invasive endovascular procedures where endograft devices are the dominant technological force. It was relatively early during these developments that the term “endoleak” was coined by White et al (Ref. 1) to denote the presence of persistent blood flow inside the aneurysm sac — but outside of the implanted endoluminal endograft device (Figure 1). In other words, they felt this was not a true “leak”, as there was no extravasation of contrast outside the aorta (“rupture”), but the presence of circulating blood and perhaps pressure | Read More

On September 7, 1990, Dr. Juan C. Parodi and his team at the Instituto Cardiovascular de Buenos Aires (ICBA, Buenos Aires, Argentina) treated the first endovascular AAA patient. The aneurysm was excluded endoluminally with a Dacron graft that was anchored at the proximal infrarenal neck with a stainless steel balloon-expandable stent. The system was assembled by affixing (with sutures) the fabric tube to an undeployed stent mounted on a large-diameter angioplasty balloon. The contraption was then sheathed inside a large-bore catheter that served as the delivery system. Access to the aorta for | Read More

I presented this topic during the recent ISET event (Figure 1), and I thought that further exposure and discussion were warranted, given the continuing relevance of the subject. While it is true that further clarity has been injected over the last few years, the matter remains largely unresolved. We could relatively easily find a number of international experts willing to defend the two extremes of the spectrum: on the one hand, there are those who maintain that the left subclavian artery (LSA) should be preserved essentially in all cases — all elective cases that is; on the other, there is | Read More

I just came back from south Florida where I participated in the excellent ISET 2010 event. One of the concurrent afternoon sessions was devoted to the always-important topic of Vascular Access, including a mini-session on percutaneous aneurysm repair, or PEVAR. In truth, the main topic is not so much whether one can access the aorta via a percutaneous stick of the one or both femoral arteries… because this is of course possible and generally quite easy, always. The real issue is whether and when to repair percutaneously the big arterial hole created by the insertion of the large-c | Read More