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Invited Commentary
May 2014

Back-Table Tailored Stent GraftsSurgeon Modified, Surgeon Approved

Author Affiliations
  • 1Department of Surgery, University of Nebraska Medical Center, Omaha
JAMA Surg. 2014;149(5):449-450. doi:10.1001/jamasurg.2013.4169

Like the first reported abdominal aortic stent grafts, most commercially sold devices, such as the one modified by Pisimisis et al,1 are tediously assembled by human hands. In reality, stent graft modification and implantation are analogous to the simpler tailoring and implantation of traditional synthetic surgical grafts. While years of clinical experience have demonstrated only rare mechanical failure of the surgical grafts themselves, concerns over stent graft durability still remain. When abdominal aortic stent grafts are pushed to their limits, they often do not perform well, especially in the long term.2 Device-dependent mechanical failures can result in expensive reinterventions, rupture, and death, ultimately erasing the short-term advantages of minimally invasive endovascular aneurysm repair.3 Food and Drug Administration–approved stent grafts are rigorously tested to perform within the constraints described in their indications for use and this is how they are best used—most of the time.

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