Konstantinos P. Donas

The initial skepticism of endovascular procedures expressed by “traditional” vascular surgeons was replaced with increasing enthusiasm, based on the belief that these less invasive techniques would have an increasingly important role in the treatment of vascular disorders. On the other hand, endovascular complications and durability issues, such as renal impairment caused by contrast medium in follow-up, raised other doubts about endovascular techniques.

Use of endovascular techniques simplifies the treatment of many demanding pathologies that would otherwise be treated by surgical means. The remarkable evolution of the endovascular toolbox expands the application of endovascular aneurysm repair (EVAR) to complex cases. Successful treatment requires clear algorithms that reflect the complementary role of endovascular and open surgical therapeutic modalities. Once the feasibility of these complex endovascular techniques has been demonstrated, the next step is to standardize the techniques and associated devices. In this context, we present in this book the endovascular repair of aortic aneurysms as performed at the Department of Vascular Surgery of St. Franziskus Hospital and University Hospital in Münster, Germany, with standard and advanced techniques.

Durability is the focus of the procedures included in this textbook and will be the focus of future scientific investigation and innovation. The absence of dedicated bridging devices in complex EVAR remains a primary area of interest. In vitro and in vivo testing of the available devices is required. Optimal performance is defined not only by patency but also by the adaptability of the anatomic conditions of the patient. This includes stability of the interaction with the main aortic endografts and the flexibility required by the often-angulated target vessels. These features play a crucial role in the durability of EVAR procedures.

The idea for the present book was born on a ship during a dinner on the Thames River in London. Professor Giovanni Torsello’s idea was to present a practical guide for colleagues who perform endovascular repair of aortic aneurysms based on the principles and techniques of the Münster group. I would like to express my deep gratitude to Professor Torsello for his sustained support and a successful 10-year clinical and scientific collaboration.