Dr. Patrick Geraghty (from Washington University, St. Louis) delivered a provoking and intriguing presentation at the recent Northwestern Vascular Symposium in Chicago that focused on the ongoing technological evolutions surrounding PAD/CLI interventions, including bioresorbable scaffolds, new drugs, adjuvant interventions, and stem and progenitor cell therapy among others. He argued these will forever change vascular surgeons’ approaches to lower-extremity revascularization. But the real thrust of the talk was his plea that this is the time, here and now, for surgeons to embrace the emerging cutting-edge technologies and new techniques. And he warned that “if our specialty fails to adapt to new treatment options, we risk getting sidelined as critical limb ischemia treatment moves into a multimodality model.”
Dr. Geraghty focused on several future directions for PAD treatment: improved drug-eluting stents (DES) for superficial femoral artery disease; drug-coated balloons and modified DES for infrapopliteal disease; biologic modifiers for claudication and CLI; and bioresorbable, drug-eluting scaffolds for infrainguinal interventions. He stated that we vascular surgeons are no longer simple plumbers… but biological response modifiers – or we should be headed in this direction. And the time is now. He also highlighted the VIBRANT trial and similar clinical studies of non–drug eluting constructs that have identified early restenosis as the primary culprit in endovascular patency loss. Reducing such early patency losses would result in fantastic primary patency rates, even when dealing with complex disease.
It seems to me the implicit message for surgeons couldn’t be more clear, or more significant. And especially so for those still clinging on to the traditional “time-honored” approaches to revascularization based on conceptually simple bypass techniques. The time has passed for plumbing alone to be successful. Modifying biology is what the foreseeable future will be all about. We must embrace these ideas right away, and pay very close attention to the new technologies and novel approaches that can and will create an exciting and brighter future in the management of atherosclerotic vascular disease. And a better future for us as vascular care providers.