Treatment of AAA in the Endovascular Era

In this issue of Vascular Disease Management, De Rango et al wrote a valuable review of the current status of AAA therapy with a major focus on how open surgical treatment has evolved in the endovascular era.

One of the most remarkable data points that I extracted from it is that centers of excellence continue to produce impressively low rates of operative mortality despite the fact that EVAR developments have “stacked the deck” against traditional surgery as many of the most difficult anatomies and patients are now being selected for open repair. It reflects abundantly on the quality and training of those surgeons and the excellence in intra- and postoperative care. But… can this be extrapolated to the surgical or hospital community at large? Almost surely the answer here is no.

Moving forward, and not unlike other surgical specialties, issues of training and trainees’ exposure to a sufficient numbers of open AAA cases will undoubtedly rise to the top of everyone’s “unmet needs” lists and solutions are not forthcoming. Regionalization of care (as mentioned in the De Rango et al article) may well become one important path to ameliorate such situations, at least in part.