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Invited Critique
Sep 2012

Could the Endo-first Strategy Really Be Better?

Author Affiliations

Author Affiliation: Division of Vascular Surgery, Stanford University Medical Center, Stanford, California.

Arch Surg. 2012;147(9):846. doi:10.1001/archsurg.2012.2021

Despite all the hoopla surrounding minimally invasive techniques that have defined the past decade of the endovascular revolution in vascular surgery, some sobering realizations have emerged. Although most vascular specialists have embraced endovascular aortic aneurysm repair, critics bemoan the loss of open aortic skill and point to durability issues as endo-enthusiasts push the boundaries. Carotid stenting vs endarterectomy continues to be a hotly debated topic for treatment, credentialing, and reimbursement. Endovascular infrainguinal interventions are still quite popular despite growing evidence that aggressive endo-first misadventures lead to worse outcomes for open leg bypass. Against this backdrop, Danczyk and colleagues1 from Oregon Health & Science University and Portland Veterans Affairs Medical Center present us with an important article regarding open reconstruction after failed endovascular attempts at treating aortoiliac occlusive disease (AIOD).

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