Physician-Modified Endografts: A New Option for Patients with Complex Aortic Aneurysms

The Vascular Center of Excellence at the TGH HVI offers patients comprehensive, goal-directed medical therapy, traditional open surgical repair, and minimally invasive endovascular therapies in the management of aortic disease, peripheral arterial and venous diseases, dialysis access, and thoracic outlet syndrome.

Our Ultrasound Vascular Laboratory has been reaccredited for an additional three-year term by the Inter-societal Accreditation Commission (IAC) in vascular testing in the areas of extracranial cerebrovascular testing, peripheral venous testing, peripheral arterial testing, and visceral vascular testing. The IAC accreditation is a seal of approval that signifies our consistent commitment to the highest level of quality care.

AORTIC DISEASE PROGRAM

The TGH Aortic Disease Program is nationally recognized as a high-volume and high-performing aortic center that offers a multidisciplinary and comprehensive approach to each patient with aortic disease. Our vascular surgeons have extensive experience with both open and endovascular techniques for abdominal aortic aneurysm repair.

As a key participant in multiple national clinical  trials examining the newest medical devices, the Vascular Center has access to cutting-edge technology for the treatment of aortic aneurysms and dissections. Led by Dr. Dean Arnaoutakis, TGH is the only center in Florida to have an FDA-approved, physician-sponsored Investigational Device Exemption (IDE) to treat complex aortic aneurysm disease with physician-modified endografts, which affords a repair option to many patients who would otherwise be turned down from surgery. Our Aortic Program is also a leader in the management of endoleaks and other failed endo-vascular therapy conditions.

“We are seeing an increasing number of patients who have had prior endovascular aortic aneurysm repairs which have failed over time for a variety of reasons. These patients are typically not candidates for explantion of these old devices, a maximally invasive operation. Fortunately, many of these patients are candidates for an endovascular repair with a physician-modified endograft, a program we uniquely offer at TGH,” said Dr. Arnaoutakis, medical director of the TGH Aortic Disease Program and University of South Florida (USF) Surgery Vice Chair of Clinical Research.

UNIQUE LIMB PRESERVATION AND COMPLEX PERIPHERAL ARTERIAL DISEASE PROGRAM

The HVI’s Limb Preservation Program is the first and only of its kind in the Tampa Bay region, offering a true multidisciplinary, integrated, evidence-based approach to the management and care of patients with complex PAD. The program coordinates care from vascular surgery to specialists, including wound care, infectious disease, podiatry, plastic surgery, cardiology, endocrinology, interventional radiology, and rehabilitation therapy. Through its Acute Limb Alert pathway, the program has been pivotal in saving the limbs of patients with abrupt loss of blood flow to their extremity.

Treatments for PAD range from medical therapy to traditional open vascular bypass and minimally invasive endovascular intervention like angioplasty, stenting, and atherectomy. Vascular surgeons in the program are actively involved in clinical research, including participation in the BEST-CLI trial to help determine whether endovascular or open treatments are preferred for critical limb-threatening ischemia.