In the evolving landscape of endovascular techniques, innovation and adaptation of endovascular procedures have significantly improved outcomes for patients with complex aortic aneurysms. One of the key advances in this field has been the development and use of physician-modified endovascular grafts (PMEGs) for aortic endografting. This presentation will explore the field of PMEGs, highlighting their robustness as a treatment option and how they are paving the way for tailored therapies in aortic endovascular therapy.
The genesis of physician-modified devices
Physician-modified devices emerged as a solution to the limitations faced by physicians in the treatment of urgent or emergency complex aortic aneurysms, particularly those involving vital side branches. By modifying commercially available endografts, physicians can create fenestrations or branches to accommodate these arteries. This presentation traces the history of PMEGs from their conceptualisation to their current status as a robust option.
Clinical results and advances
A significant portion of the lecture will be devoted to reviewing the clinical outcomes associated with the use of PMEGs. Studies have shown that PMEGs can achieve comparable success rates to off-the-shelf or custom-made devices, particularly in patients with anatomically challenging aortic aneurysms. In addition, advances in imaging techniques and computational modelling have increased the precision with which these devices can be modified, further improving patient outcomes.
Challenges and ethical considerations
Despite the promising benefits of PMEGs, their use is not without challenges. This presentation will address the technical complexities involved in modifying endografts, the steep learning curve for physicians, and the regulatory and ethical considerations associated with the use of non-standard, physician-modified devices. It also touches on the ongoing debate within the medical community regarding the balance between innovation and patient safety.
The future of physician-modified devices
Looking to the future, the presentation explores the potential for further innovation in the design and use of PMEGs. With the advent of new materials, 3D printing technology and artificial intelligence, there is a promising horizon for even more personalised and effective solutions for aortic endografting. The role of collaborative research and multidisciplinary teams is emphasised as crucial for the advancement of this field.
Conclusion
Physician-modified devices represent a significant leap forward in the treatment of complex aortic aneurysms. By offering a personalised solution, PMEGs have the potential to improve outcomes for patients who may otherwise face significant risks or lack appropriate treatment options. As the field continues to evolve, continued refinement of these devices and techniques promises to further enhance their efficacy and applicability.
