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 emerge differently, and be of another nature. Biological and molecular manipulations will be pre-eminent and overshadow anything mechanical we admire today: they will relegate plumbing solutions and plumbers to their rightful secondary role…”

And now back to the realities of the real world:

The other night, while in Malmo, Sweden, at a very nice conference dinner during the renowned Critical Issues Workshop on Aortic Endografting, I was sitting right across the table from the event’s director and main organizer, my good friend Dr. Martin Malina: a renowned expert in the field of aortic endovascular repair and Chief of Vascular Surgery at the Malmo-Lund University Hospital. And for some reason, he started talking about plumbers, mechanical solutions and the like as they relate to endovascular treatment of complex aortic diseases. The two of us, together with a few others who gradually joined the conversation, began to review quickly some of the most recent advancements in thoracic aortic endografting and the new tools and solutions that various experts and operators have devised to help us address a host of complex lesions and diseases which can now be treated without major invasive surgery in an ever-growing proportion of such patients. And we all realized, almost immediately, that most of these revolutionary endovascular tools and solutions are mechanical in nature. Put simply: plumbing solutions! Here’s a quick short list: new thoracic endografts designed to hug and conform to the lesser curve of the aortic arch knuckle (bend), in-situ fenestrations and chimney grafts, truly branched endografts for use in the arch and visceral segments, and emerging new ideas and designs to address the ascending aorta and the aortic root/aortic valve complex.

From such a perspective, we rapidly concluded that bio-mechanics have much to offer, and that plumbing and plumbers are not going away any time soon. It seems that pronouncements about their upcoming inevitable demise may be a bit premature, largely inaccurate, and essentially off-base!

What do you think??

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Dr. Frank J Criado is a Board-Certified Vascular Surgeon and Endovascular Specialist at the Union Memorial Hospital-MedStar Health in Baltimore, Maryland – USA.

Dr. Criado is widely acknowledged to be a pioneer in endovascular therapy, with a 20-year + interventional experience. He has contributed extensively to the literature with more than 100 peer-reviewed published articles – mostly on various vascular and endovascular subjects, and Editor-in-Chief of Vascular Disease Management (VDM). He has also been active in clinical research, with a major focus on aortic stent-graft and carotid interventions, and endovascular technologies in general. He was the National Principal Investigator (P.I.) for the Medtronic Talent AAA clinical trials in the U.S., and a member of the Executive Committee for the Medtronic Valor Thoracic trial.

He is a founding member and immediate past President of the International Society of Endovascular Specialists (ISES), founder and current President of the endovascular surgery society of Latinamerica (CELA), and a member of all major U.S. and international vascular and endovascular societies. He is a Fellow of the American College of Surgeons (FACS) and of the Society of Vascular Medicine (FSVM), and a member of the Board of Directors of the Society for Vascular Surgery (SVS).