title: Developing a complex endovascular fenestrated and branched aortic program.
abstract: In 2008, the top priority in our division's 5-year strategic plan was "to become an internationally recognized center of excellence for the endovascular treatment of complex aortic pathology extending from the aortic valve to the external iliac artery." Five components were identified as "most critical" to achieve this strategic priority: (1) training at centers of excellence in complex endovascular repair; (2) industry partnership to improve access to developing technologies; (3) a fully integrated team approach with one leader involved in all steps of all cases; (4) prospective data collection; and (5) development and implementation of a physician-sponsored investigational device exemption for juxtarenal, pararenal, and thoracoabdominal aneurysms. We have now performed 49 repairs (16 commercially manufactured devices, 33 physician-modified devices) for 3 common iliac, 20 juxtarenal, 9 pararenal, and 17 thoracoabdominal aneurysms, using 142 fenestrations, branches, and scallops. All patients had complete 30-day follow-up for calculation of 30-day events. Kaplan-Meier analysis was used to calculate 1-year events. In 5 years, we developed a successful complex endovascular aortic program that uses fenestrated/branched repair techniques. A focused team strategic planning approach to program development is an effective way for vascular surgery divisions to gain experience and expertise with new complex technologies while ensuring acceptable patient outcomes.
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass. Electronic address: andres.schanzer@umassmemorial.org.
authors.forename: Andres
authors.initials: A
authors.lastname: Schanzer
authors.affiliation: Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pa.
authors.forename: Donald
authors.initials: D
authors.lastname: Baril
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: William P
authors.initials: WP
authors.lastname: Robinson
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Simons
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Francesco A
authors.initials: FA
authors.lastname: Aiello
authors.affiliation: Division of Vascular Surgery, University of Massachusetts Medical School, Worcester, Mass.
authors.forename: Louis M
authors.initials: LM
authors.lastname: Messina
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000193:education / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D002983:Clinical Competence; D003299:Cooperative Behavior; D004503:Education, Medical, Graduate / Q000458:organization & administration; D057510:Endovascular Procedures / Q000009:adverse effects / Q000193:education / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D005260:Female; D019981:Health Care Sector / Q000458:organization & administration; D006801:Humans; D033183:Interdisciplinary Communication; D007373:Interinstitutional Relations; D053208:Kaplan-Meier Estimate; D008297:Male; D017146:Models, Organizational; D009937:Organizational Objectives; D010348:Patient Care Team / Q000458:organization & administration; D011216:Practice Management, Medical / Q000458:organization & administration* / Q000592:standards; D016730:Program Development; D015397:Program Evaluation; D011474:Prosthesis Design; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome