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J Thorac Cardiovasc Surg 2007;133:285-288
© 2007 The American Association for Thoracic Surgery

Editorial

Endovascular stenting for descending aneurysms: Wave of the future or the emperor’s new clothes?

Section of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Conn.

Received for publication September 24, 2006; accepted for publication September 28, 2006.

^_* Address for reprints: John A. Elefteriades, MD, Section of Cardiothoracic Surgery, Yale University School of Medicine, 333 Cedar St (121 FMB), New Haven, CT 06510. (Email: john.elefteriades@yale.edu).

The first 300 words of the full text of this article appear below.

Cardiothoracic surgeons owe a debt of gratitude to Bavaria and colleagues¹ for spearheading these exciting clinical investigations into novel endovascular therapies for aneurysm disease from within the specialty of cardiothoracic surgery. This provides the opportunity for these investigations to be imbued with decades² of collective wisdom from the perspective of cardiothoracic surgery. This also provides the opportunity for our specialty to continue leadership in the treatment of these diseases as technology advances.

The article by Bavaria and colleagues¹ represents a large, multicenter comparative trial between traditional aortic surgery and endografting for descending thoracic aortic aneurysms. The study is well conceived and well presented and demonstrates satisfactory early performance of the endografts. This is very important work, vital to the advancement of the field, for which the investigators are to be congratulated.

It is extremely important to evaluate endograft therapy of aneurysms in organized clinical trials. Ultimately, randomized trials of thoracic endografts versus open surgical repair will be required for strongly based conclusions to be drawn.

It is important for medical science to evaluate endografting of aneurysms with enthusiasm for this new modality but, at the same time, with a grain of skepticism or at least realism. Multiple reasons to be cautious can be cited.

Conceptual Issues

First, some question the very concept of repair of an expanding cylindrical structure by means of a graft placed within its lumen. Stents, it is pointed out, were developed to keep arteries from closing in (as in coronary angioplasty), not to keep them from expanding outward. How can a graft placed inside an enlarging aorta and not attached to the aorta prevent the inexorable expansion of that aorta? Some say the graft would have to go outside, not inside, the aorta, a concept that was tried and failed many years ago. To control a herd of . . . [Full Text of this Article]

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