As a vascular surgeon, I am constantly evaluating advances that help us care for our patients. I think this is especially true with the rapidly changing medical device technologies. I think we generally fall into three categories when considering new techniques: “the immediate-users, the wait-and-seers, and the complete naysayers.”

I have usually taken the “wait-and-see” approach. This is especially true for EVAR performed in a percutaneous manner. I have spoken to colleagues, heard about the training courses, and have seen some data in the literature. I have always said that it is “just a little groin incision,” and have never felt the desire to change my approach to EVAR.

I recently moved to a new hospital in Chicago. As I help develop our program, I have become interested once again in this approach, particularly after a successful case performed by one of my partners. Our center has performed a number of procedures since that time, with excellent success. We have been careful to select patients with relatively large femoral arteries and minimal calcification, and have not had a conversion to an open femoral artery repair yet. As a result, we have begun to relax our strict indications.

The p-EVAR experience has reinforced my “wait-and-see” approach. Our patients are happy, and we are not experiencing complications with a new technique. Outside of clinical trials, I think this is a safe approach for our patients.

Ross Milner, MD

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Ross Milner, MD, FACS is associate professor of surgery at Loyola University Chicago Stritch School of Medicine. He was recruited to Loyola from Emory University School of Medicine in Atlanta, where he was associate professor of surgery.

Dr. Milner graduated Cum Laude from the University of Pennsylvania, where he also completed medical school. He was chief resident in surgery at the Hospital of the University of Pennsylvania. He completed fellowships at the University of Pennsylvania and University Medical Center in Utrecht in the Netherlands.