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AATS/NHLBI: Cardiothoracic Surgery Exploring Collaborative Clinical Research Opportunities

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Title and Author
Vascular Surgery and Endovascular Therapy
Ronald Fairman

Abstract
Although the practice of vascular surgery has been transformed over the last 15 years with the advent of endovascular abdominal and thoracic aortic aneurysm repair as well as carotid stenting with distal protection, there remain a considerable number therapeutic knowledge gaps and opportunities for future investigations. Below is a list of potential clinical research studies; the order is not indicative of perceived importance.
  1. A randomized prospective study of surgical bypass Vs. endovascular repair of popliteal artery aneurysms.
  2. A randomized prospective study of surgical bypass Vs. endovascular management for critical limb ischemia.
  3. A comparative study of carotid endarterectomy Vs. carotid stenting prior to CABG in patients with severe carotid stenosis, symptomatic or otherwise.
  4. Current best management of asymptomatic carotid stenosis: aspirin/plavix/statin medical therapy Vs. carotid intervention.
  5. Comparative study of branched aortic endografting Vs open repair for aortic aneurysms involving the visceral segment.
  6. A randomized study to define the optimal approach for the residual type B dissection following open Type A dissection repair: "frozen elephant stent" Vs no stent and watchful waiting.
  7. Ideal endovascular management of infrapopliteal occlusive disease: Drug coated balloons Vs. standard PTA.
  8. Given the poor long term survival following EVAR and TEVAR (reported mortality rates as high as 40% for EVAR at 4 years and 20% for TEVAR at 1 year), we need to identify variables and methods to predict poor survival following aortic endovascular procedures.


Key Research Gap Requiring NHLBI Leadership
  1. Defining new strategies for stroke prevention (> 8%) during TAVI (transcatheter aortic valve implantation) as well as other aortic arch endovascular interventions for aneurysmal disease.


Key Citations
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