Interview Questions for Hybrid Vascular Surgery

Endovascular aneurysm repair (EVAR) is a minimally invasive technique used to treat abdominal aortic aneurysms (AAA). Instead of a large open surgery, we access the aneurysm via the femoral artery in the groin using small incisions. We then deploy a stent-graft, a specialized device that lines the aneurysm, excluding it from the blood flow and preventing rupture. My experience encompasses a wide range of EVAR cases, from straightforward deployments in simple aneurysms to complex repairs involving challenging anatomies like iliac tortuosity or short necks. I’ve utilized various stent-graft designs and have managed numerous post-operative scenarios, including endoleaks (leakage of blood around the stent-graft) and stent-graft migration. One particularly memorable case involved a patient with severe vascular calcification, necessitating meticulous pre-operative planning and intra-operative adjustments to successfully deploy the stent-graft.

For instance, in a case with a short neck aneurysm, which is usually a challenging anatomical scenario, we utilize specific techniques such as fenestrated or branched endografts to achieve successful exclusion. This requires detailed pre-operative imaging analysis, meticulous stent-graft selection and placement, and careful post-operative monitoring. In another scenario, I’ve managed complications like type II endoleaks by employing embolization techniques.

Hybrid approaches in carotid artery disease combine the benefits of both open surgery and endovascular techniques. For example, a hybrid approach for carotid artery stenosis might involve an endovascular approach for one carotid artery and a conventional carotid endarterectomy for the other.

• Advantages: Reduced surgical trauma, shorter hospital stays, faster recovery times, potential for less neurological complications in selected patients. Imagine a patient with severe comorbidities who might not tolerate a traditional open surgery. A hybrid approach offers a less invasive alternative, improving their chances for a successful outcome.
• Disadvantages: Requires specialized skills and expertise in both open and endovascular techniques. Can be more technically challenging than either approach alone, and increased potential for hybrid-specific complications like access site issues or device-related problems. It is essential to carefully weigh the advantages and disadvantages based on patient-specific factors such as the location and extent of the stenosis, overall health status, and procedural risks.

Patient selection for hybrid vascular procedures is crucial. It’s not a one-size-fits-all approach. Key considerations include:

• Anatomical suitability: The anatomy of the blood vessels must be conducive to both the endovascular and open surgical components of the procedure. For example, certain aneurysms are simply not suitable for EVAR. A thorough imaging assessment using CT, MRI or angiography is essential.
• Overall health status: Patients with significant comorbidities (e.g., heart failure, severe lung disease, renal insufficiency) might benefit from a less invasive hybrid approach, but their overall health status must be carefully evaluated to determine their ability to tolerate the procedure and its potential risks.
• Life expectancy: Hybrid procedures are often reserved for patients with a reasonable life expectancy to ensure the benefits outweigh the risks and costs.
• Surgical expertise: The surgeon must have experience with both endovascular and open surgical techniques and a thorough understanding of the potential complications related to each.

In essence, a multidisciplinary approach – involving vascular surgeons, interventional radiologists, anesthesiologists, and other specialists – is often employed to optimize patient selection and surgical planning.

Managing complications during hybrid vascular surgery requires a proactive approach and rapid response. Potential complications can include bleeding, infection, nerve injury, thrombosis, and organ damage, specific to either the open or endovascular portion, or issues related to the combination of techniques. Our strategy involves:

• Meticulous surgical technique: Minimizing trauma and careful hemostasis are paramount throughout the procedure.
• Continuous monitoring: Close monitoring of vital signs, neurological function, and blood flow is essential.
• Intraoperative imaging: Fluoroscopy (real-time X-ray imaging) helps guide the endovascular procedures and detect potential complications early.
• Immediate post-operative care: Close monitoring of the patient in the recovery room and ICU is critical to detect and treat potential issues promptly.
• Post-operative management: This includes meticulous wound care, pain management, anticoagulation therapy, and regular follow-up imaging studies to assess the long-term outcome of the procedure.

For example, if we encounter a type II endoleak during EVAR, we might use embolization coils to seal the leak. In cases of bleeding, we employ pressure dressings or surgical intervention as needed.

Minimally invasive saphenous vein harvesting (MISVH) is a technique used to obtain saphenous veins for bypass grafting with smaller incisions and less tissue trauma than traditional open harvesting. My experience includes using both endoscopic and small-incision techniques, employing techniques like laser-assisted vein harvesting. MISVH offers several advantages such as reduced postoperative pain, faster recovery time, improved cosmetic results and potentially reduced risk of infection compared to traditional open harvesting. However, it requires specialized training and equipment, and may not be suitable for all patients.

For instance, in one case involving a patient with significant comorbidities, MISVH allowed us to perform a successful bypass with minimal added stress. The reduced recovery time meant a quicker return to their normal activities. However, it’s critical to remember that MISVH may not be suitable in all cases. Certain anatomical variations or vein quality issues may necessitate a traditional approach.

My familiarity with endovascular devices is extensive. This includes various types of stent-grafts for aortic and peripheral aneurysms, different types of balloon catheters for angioplasty and stenting, embolization coils and glue for treating endoleaks and fistulas, and various intravascular ultrasound (IVUS) and angiography catheters for imaging and assessment. I am proficient in using devices from multiple manufacturers and choosing the appropriate device based on the specific clinical scenario. Understanding the capabilities and limitations of each device is critical for successful outcomes and minimizing complications.

For instance, I would use a fenestrated or branched stent-graft for a complex aortic aneurysm involving visceral arteries, while a simple stent-graft would suffice for a simpler case. The selection is guided by pre-operative imaging, the patient’s anatomy, and the desired outcome. We use IVUS to ensure accurate stent deployment and assess the treated vessel.

Pre-operative planning for complex hybrid cases is critical to ensure the safety and success of the procedure. This involves a multidisciplinary approach, starting with detailed imaging studies (CT, MRI, angiography) to meticulously assess the anatomy of the involved blood vessels. We then create 3D models of the vasculature for better visualization and planning of the procedure, and often use simulation software to help with device selection and procedural steps. Discussions with the patient concerning the risks and benefits of the chosen approach are crucial and informed consent is paramount. It’s a collaborative effort, often involving cardiac surgery, interventional radiology, anesthesia, and nursing colleagues.

For example, in a case involving both a complex abdominal aortic aneurysm and significant iliac artery disease, we would work closely with the interventional radiology team to plan the appropriate endovascular approach and stent-graft selection, carefully considering the relationship between the abdominal and pelvic vasculature. We might perform a combined procedure, with the endovascular component preceding the open surgery component to optimize access and minimize complications.

Preoperative imaging is absolutely crucial in hybrid vascular surgery. It allows us to meticulously plan the procedure, minimizing invasiveness and maximizing efficacy. We utilize a multi-modal approach, integrating information from different imaging techniques to create a comprehensive picture of the patient’s vascular anatomy.

• CT Angiography: Provides excellent visualization of the vasculature, including the location, extent, and morphology of aneurysms, stenosis, or occlusions. We use this to assess the suitability of endovascular techniques and to plan the precise placement of stents or grafts.
• MRI Angiography: Offers superior soft tissue contrast, which is particularly helpful in evaluating the relationship of the vessels to adjacent structures, like nerves or organs. This is essential for minimizing the risk of injury during both open and endovascular components of the hybrid procedure.
• Conventional Angiography: While less frequently used as a primary planning tool due to its invasiveness, it remains valuable in selected cases for confirming the findings of CT or MRI and assessing vessel patency before and after endovascular intervention. It allows for real-time visualization during the procedure.

For example, in a case of an abdominal aortic aneurysm (AAA), we would use CT angiography to determine the aneurysm size, location, and the involvement of the renal and iliac arteries. This information dictates whether we’d proceed with an endovascular stent-graft or an open repair, or a combination of both. MRI angiography may help assess the presence of any thrombus within the aneurysm and the proximity of the aneurysm to the spine.

Perioperative management in hybrid vascular surgery requires a multidisciplinary approach. It’s a delicate balance between optimizing the patient’s condition for the procedure and minimizing complications. We emphasize careful patient selection, thorough preoperative assessment, and a comprehensive postoperative monitoring strategy.

• Preoperative Optimization: This includes addressing any comorbidities like diabetes, hypertension, or renal insufficiency. We strive to optimize the patient’s blood pressure, blood sugar levels, and hemoglobin levels. We might involve other specialists, such as cardiologists or nephrologists, to ensure that the patient is in the best possible condition before surgery.
• Intraoperative Management: This involves careful hemodynamic monitoring, maintaining normothermia, and minimizing blood loss. We use meticulous surgical techniques to minimize trauma to the tissues. During the endovascular portion, we use image guidance to ensure precise placement of devices and minimize radiation exposure.
• Postoperative Management: This includes careful monitoring of vital signs, wound care, pain management, and early mobilization. We watch closely for complications like bleeding, infection, or graft thrombosis. Regular blood tests, imaging studies, and clinical examinations are essential to track recovery and identify any potential issues early.

Imagine a patient with a complex iliac artery occlusion. Preoperative optimization might involve optimizing their blood pressure and using medication to manage their diabetes. Intraoperatively, we might use a combination of open surgical bypass and endovascular stenting. Postoperative care would focus on preventing infection and monitoring graft patency.

Success in hybrid vascular surgery is multifaceted and measured by a combination of key performance indicators (KPIs). We focus on both short-term and long-term outcomes.

• Immediate Postoperative Outcomes: These include the rate of successful procedural completion, the amount of blood loss, the length of hospital stay, and the incidence of immediate complications like bleeding, infection, or neurological deficits.
• Long-Term Outcomes: These include patency of the repaired vessel(s), freedom from reintervention, patient survival, and improvement in patient quality of life, as assessed by validated questionnaires.
• Technical Success: This is defined as achieving the primary procedural goal (e.g., successful placement of the stent-graft, restoration of blood flow). We meticulously document the details of the procedure and analyze outcomes to improve our technique over time.

For instance, in treating an aortic dissection, technical success would be complete exclusion of the dissected aorta. Long-term success would be measured by the patient’s survival and freedom from subsequent aortic events, along with improved quality of life.

Bleeding is a significant potential complication in hybrid vascular surgery, particularly during the open surgical component. Our approach emphasizes meticulous surgical technique and proactive measures to prevent and manage bleeding.

• Prophylactic Measures: These include optimizing the patient’s coagulation status preoperatively, using meticulous surgical technique with minimal tissue trauma, and employing appropriate hemostasis techniques, such as the use of surgical sealant or fibrin glue.
• Intraoperative Management: We use meticulous surgical techniques, such as precise vessel dissection, ligation, and appropriate use of sutures and clips, to minimize blood loss during open surgical procedures. During endovascular procedures, we use specialized embolization coils or other devices to control bleeding from any puncture sites.
• Postoperative Management: Close monitoring of vital signs, including blood pressure, heart rate, and urine output, is crucial. If bleeding occurs, we may utilize blood transfusions, surgical intervention to control the bleeding source, or interventional radiological techniques to embolize bleeding vessels.

If a patient experiences significant bleeding during an open repair of a femoral artery, we may use direct pressure, surgical ligation, or angiographic embolization to control the bleeding. Post-operatively, we’d monitor closely for signs of hypovolemia (low blood volume) and address them promptly.

The choice of vascular graft is crucial to the success of a hybrid procedure. The selection depends on factors such as the location and size of the defect, the patient’s overall health, and the specific surgical technique.

• Dacron grafts (Polyester): These are widely used for open surgical repairs and are particularly suitable for large vessel reconstruction. They are durable and have a good long-term patency rate, although they are prone to thrombogenicity initially requiring anticoagulation therapy.
• PTFE (Polytetrafluoroethylene) grafts: These are also used for open procedures, but are often preferred for smaller vessels or areas with difficult surgical access. PTFE grafts are less thrombogenic than Dacron, but they can be more prone to kinking or crimping.
• Biologic grafts (e.g., saphenous vein): Autologous saphenous veins are excellent choices in many instances. They offer superior biological compatibility and minimal thrombogenic risk when used in bypass procedures, though availability and quality can vary.
• Endovascular stents and stent-grafts: These are deployed during endovascular procedures. Stent grafts are self-expanding devices that provide a scaffolding for the vessel and restore blood flow, often for treating aneurysms.

For instance, in an AAA repair, a Dacron stent-graft might be used endovascularly, while in a peripheral artery bypass, a saphenous vein graft might be used for an open surgical bypass. The choice depends on the specific case characteristics and surgeon preference.

Access techniques in endovascular surgery are critical for successful deployment of devices and minimizing patient complications. The choice of access site is crucial and is tailored to the specific procedure and patient anatomy.

• Femoral artery access: This is the most common access site, providing excellent access to the majority of the arterial tree. It’s usually performed under ultrasound guidance, with local anesthesia.
• Brachial artery access: Used less often, the brachial artery is an alternative access point, particularly useful in cases with iliofemoral disease obstructing femoral access.
• Radial artery access: This less commonly used access site offers potential advantages like reduced hematoma risk and faster patient recovery. However, it may not always be suitable for all procedures due to the smaller vessel size.
• Trans-axillary access: This is used less frequently for larger vessels but is a valuable approach for certain complex aortic interventions.

The choice of access site involves a careful balance between procedural success and patient comfort and safety. For example, in a patient with significant peripheral arterial disease affecting the femoral arteries, we might opt for brachial access to facilitate endovascular procedures.

Hybrid vascular surgery offers significant advantages over traditional open surgery, but it also presents unique challenges and limitations.

• Advantages: Minimally invasive nature, reduced surgical trauma, shorter hospital stay, faster recovery, lower risk of major complications, improved cosmetic outcomes.
• Disadvantages: Higher procedural complexity, requirement for specialized equipment and expertise, potential for radiation exposure during endovascular component, the risk of device-related complications such as stent thrombosis or migration, and occasionally limited applicability to complex anatomical situations.
• Limitations: Not every vascular problem is amenable to a hybrid approach. In cases of severe calcification, severe tortuosity of vessels, or extensive tissue damage, open surgery might remain the preferred method.

A patient with a complex aortic aneurysm involving significant calcification might be better suited to an open repair even though a hybrid approach may be attempted initially in simpler cases. The decision to use open or hybrid surgery is complex and requires careful consideration of individual patient factors and the expertise of the surgical team.

Addressing patient concerns and expectations regarding hybrid vascular procedures is paramount. It starts with a thorough and empathetic pre-operative consultation. I explain the procedure in clear, non-technical terms, using analogies where appropriate. For instance, when explaining endovascular techniques, I might compare the catheter to a tiny plumber’s snake navigating the arteries. I discuss the advantages of the hybrid approach – the combination of minimally invasive endovascular techniques with open surgery where necessary – highlighting the potential for smaller incisions, reduced recovery time, and less scarring compared to traditional open surgery. However, it’s equally crucial to manage expectations realistically. I explain potential risks and complications, emphasizing that while the hybrid approach often offers significant benefits, it’s not a risk-free procedure. Open communication and shared decision-making are key. I actively encourage patients to ask questions and address any anxieties they may have. Post-procedure, I maintain open communication, providing regular updates on their progress and addressing any concerns promptly. This holistic approach builds trust and contributes to better patient outcomes and satisfaction.

Current research trends in hybrid vascular surgery are focused on several key areas. One major trend is the development of less invasive techniques. This includes advancements in catheter technology, allowing for more precise and targeted interventions with reduced trauma to surrounding tissues. Another area of active research is the improvement of imaging techniques, such as advanced CT and MRI, to allow for better pre-operative planning and intra-operative guidance. This precision minimizes complications. Furthermore, researchers are exploring the use of biocompatible materials and coatings for stents and grafts to improve long-term patency and reduce the risk of thrombosis. Personalized medicine is also playing a significant role, with researchers focusing on identifying biomarkers and genetic factors that can predict patient response to specific treatments. Lastly, artificial intelligence (AI) is being integrated into hybrid vascular surgery, with algorithms being developed to assist in surgical planning, intra-operative decision-making, and post-operative risk stratification. The ultimate goal is to create more effective, safer, and personalized treatments for vascular diseases.

My experience with robotic-assisted hybrid vascular surgery has been overwhelmingly positive. The enhanced dexterity and precision offered by the robotic system, especially in complex anatomical locations, significantly improves the accuracy of endovascular procedures. For example, in cases of challenging aortic aneurysms, the robotic arms allow for precise deployment of stents and grafts, minimizing the risk of perforation or malpositioning. The magnified, 3D high-definition visualization provided by the robotic system also aids in identifying and addressing subtle anatomical variations that might be missed during conventional laparoscopic or open surgery. While the learning curve for robotic-assisted procedures is steeper, the enhanced precision and potential for improved patient outcomes justify the investment in training and technology. I’ve personally observed decreased operative times and less blood loss in several cases, leading to improved patient recovery times. I believe that robotic-assisted hybrid vascular surgery represents a significant step forward in the field and will continue to play an increasingly important role in the management of complex vascular diseases.

Staying updated on the latest advancements is crucial in this rapidly evolving field. I actively participate in professional organizations such as the Society for Vascular Surgery (SVS) and the American College of Surgeons (ACS), attending conferences and workshops regularly. I also subscribe to leading vascular surgery journals and actively review pertinent publications. Continuous professional development is a priority, and I regularly engage in online courses and webinars to expand my knowledge. Furthermore, participation in multidisciplinary case conferences with colleagues from different specialties, including interventional radiology and cardiology, allows for exposure to diverse approaches and techniques. Finally, close collaboration with industry experts and participation in research projects help to maintain a current understanding of the latest technological innovations and treatment strategies.

Technology plays a transformative role in improving outcomes in hybrid vascular surgery. Advancements in imaging technology, such as multi-slice CT scanners and 3D-printed models based on patient scans, drastically enhance pre-operative planning and procedural accuracy. This pre-planning reduces the need for extensive open surgery. Intra-operatively, real-time imaging systems, such as intravascular ultrasound (IVUS) and near-infrared spectroscopy (NIRS), provide critical information to guide catheter navigation and stent deployment, optimizing treatment outcomes. Robotic surgery platforms, as mentioned earlier, enhance precision and minimize invasiveness. Post-operatively, advanced monitoring technologies and data analytics help predict and prevent complications. In essence, technological integration translates to less invasive procedures, greater accuracy, shorter hospital stays, reduced complications, and ultimately, improved patient quality of life. For example, the use of 3D printing to create personalized stents and grafts is a significant step towards personalized medicine, optimizing treatment for individual anatomical variations.

Managing patients with complex co-morbidities undergoing hybrid vascular procedures requires a multidisciplinary approach. Pre-operative optimization of these patients is crucial. This often involves close collaboration with specialists in cardiology, pulmonology, nephrology, and endocrinology to address any underlying medical issues. Careful assessment of cardiac and respiratory function is essential to minimize surgical risks. Patients with renal insufficiency may require specific management strategies to prevent acute kidney injury. The surgical plan is tailored to address the patient’s specific needs and comorbidities, sometimes requiring a staged approach. Careful selection of anesthetic agents and postoperative monitoring are necessary to optimize patient safety. For instance, a patient with severe COPD might require a less invasive endovascular-only approach to reduce the risks associated with general anesthesia and a large surgical incision. Each patient’s risk profile is thoroughly assessed, and the treatment plan is developed in close collaboration with the patient and their family, taking into account their individual circumstances and preferences.

Managing postoperative complications in hybrid vascular surgery patients requires vigilance and a proactive approach. Common complications can include bleeding, infection, thrombosis, and graft failure. Early detection is key, and this is achieved through meticulous postoperative monitoring, including vital signs, blood counts, and imaging studies as needed. Prompt intervention is crucial to minimize the impact of any complications. For example, early detection of a bleeding site may require immediate surgical intervention, while prompt initiation of anticoagulation therapy may prevent thrombotic events. Regular follow-up appointments, including imaging studies, are essential to monitor graft patency and detect any potential problems. A multidisciplinary team approach ensures appropriate and timely management of complications. A strong emphasis on patient education regarding signs and symptoms of complications empowers patients to actively participate in their care and seek prompt medical attention if needed. The ultimate goal is to minimize morbidity, mortality, and improve long-term patient outcomes.

Selecting the optimal approach – hybrid versus open – for vascular surgery hinges on a meticulous patient assessment. We consider several crucial factors. First, the patient’s overall health and comorbidities play a significant role. A patient with severe heart or lung disease might not tolerate the invasiveness of an open procedure as well as a less invasive hybrid approach. Second, the anatomical location and complexity of the vascular lesion are vital. For example, a relatively straightforward iliofemoral stenosis might be suitable for a purely endovascular (minimally invasive) procedure, a component of the hybrid approach. However, a complex aortic aneurysm requiring extensive reconstruction may necessitate an open surgical component. Third, we carefully evaluate the lesion’s suitability for endovascular intervention. Some lesions are simply not amenable to stent placement or other minimally invasive techniques. Finally, patient preference, informed by a comprehensive discussion of the risks and benefits of each approach, is crucial in shared decision-making.

Example: A 75-year-old patient with significant comorbidities presenting with iliac artery stenosis might be a perfect candidate for a hybrid approach – endovascular stent placement in the iliac arteries combined with a smaller, less invasive open surgical approach to address a local complication or challenging anatomy not amenable to endovascular intervention. In contrast, a younger, healthier patient with a complex thoracoabdominal aneurysm would likely require a more extensive open surgical procedure.

Ethical considerations in hybrid vascular surgery are paramount. Informed consent is absolutely critical. Patients must fully understand the procedure’s risks, benefits, alternatives (including open surgery and conservative management), and potential complications. Transparency regarding the learning curve inherent in newer techniques and the possibility of needing conversion to an open procedure is also essential. We must also carefully weigh the potential benefits of a less invasive procedure against any potential increased risks associated with a hybrid approach, particularly the learning curve or technological challenges. Furthermore, equitable access to these advanced procedures is a key ethical concern. We must ensure that patients are not disadvantaged based on socioeconomic status, geographic location, or other factors.

Example: A patient might have a preference for a minimally invasive procedure, but if their anatomy is unsuitable, we have an ethical obligation to explain this thoroughly and recommend the safest and most effective approach, even if it means open surgery.

Intraoperative complications during hybrid procedures demand a rapid and decisive response. The specific management strategy depends entirely on the nature of the complication. For example, uncontrolled bleeding might require immediate conversion to open surgery, meticulous haemostasis, and potentially blood transfusion. If a stent malposition occurs, we might attempt to reposition it endovascularly; however, if this fails, open surgery might be necessary. Damage to adjacent structures (e.g., nerves or bowel) might necessitate repair with either endovascular techniques or an open surgical approach, depending on the extent of the injury and the surgeon’s expertise and capabilities. Throughout this process, clear communication with the surgical team, anesthesia team, and the patient’s family is crucial. A systematic approach, prioritizing the patient’s safety, is essential in any complex surgical emergency.

Example: If significant bleeding occurs during an endovascular aneurysm repair (EVAR), we would immediately convert to an open surgical repair to achieve haemostasis and secure the aneurysm. This requires quick decision-making and a seamless transition between the endovascular and open surgical techniques.

Vascular stents come in a variety of designs and materials, each with specific applications. Bare metal stents (BMS) are the simplest, providing structural support to prevent collapse of the vessel. However, they are prone to restenosis (renarrowing of the vessel). Drug-eluting stents (DES) incorporate medication to inhibit cell proliferation and reduce the risk of restenosis. They are particularly useful in treating lesions with a high risk of restenosis. Covered stents, unlike bare metal and drug-eluting stents which are designed to leave the lumen open, are used to exclude aneurysms or seal off leaks. They are essential for procedures like EVAR. Bioabsorbable stents, which gradually dissolve over time, aim to minimize long-term foreign body effects. The choice of stent depends on factors like lesion location, length, and morphology, as well as patient characteristics.

Example: A short, focal stenosis in the superficial femoral artery might be successfully treated with a DES. Conversely, an abdominal aortic aneurysm might require a covered stent-graft within an EVAR procedure.

Infection management following hybrid vascular procedures is crucial for patient recovery and preventing serious complications. Prophylactic antibiotics are always administered before the procedure. Meticulous surgical technique, maintaining a sterile field and meticulous haemostasis, helps prevent infection. Post-operatively, careful wound care is paramount. We monitor patients closely for signs of infection (fever, erythema, purulence) and promptly administer appropriate antibiotics based on culture results. In cases of deep surgical site infection, debridement and possible surgical revision might be necessary. Patient education on wound care and hygiene is essential in preventing infection.

Example: A patient presenting with fever and local inflammation around a surgical incision a few days after a hybrid procedure would undergo a thorough assessment and prompt antibiotic treatment based on culture and sensitivity testing.

Evaluating long-term outcomes after hybrid vascular surgery involves a multi-faceted approach. We use a combination of clinical assessments, imaging studies (such as ultrasound, CT angiography, or MRI), and patient-reported outcome measures. Clinical follow-up appointments focus on assessing symptoms, checking for recurrent stenosis or aneurysm expansion, and monitoring for complications. Imaging studies allow us to visualize the treated vessel and assess the patency of the stent or graft. Patient-reported outcome measures capture aspects of quality of life, functional capacity, and overall well-being. This comprehensive approach provides a thorough understanding of treatment efficacy and long-term patient outcomes.

Example: Regular surveillance CT angiography would allow us to monitor for aneurysm expansion in a patient who had undergone a hybrid approach for an aortic aneurysm. Patient reported outcome measures (PROMs) would assess the impact of the procedure on their ability to perform daily activities.

3D printing and other advanced technologies are revolutionizing hybrid vascular surgery. 3D-printed models of patient-specific anatomy are invaluable for pre-operative planning, allowing surgeons to meticulously assess the vascular anatomy, plan the optimal approach, and rehearse the procedure. This reduces intraoperative complications and improves surgical outcomes. Computer-aided design (CAD) software enhances stent design and customization, further optimizing results. Image-guided navigation systems provide real-time intraoperative visualization, ensuring precise placement of stents and other devices. Robotic surgery further enhances precision and dexterity during minimally invasive procedures. These technologies are improving patient care and expanding the capabilities of hybrid vascular surgery.

Example: Using a 3D-printed model of a patient’s aortic anatomy allowed us to plan the precise placement of a stent-graft during an EVAR, leading to a smoother, safer procedure.