«The prosthesis revolution allows us to perform surgeries that were previously unthinkable»

Technological innovation is one of the most powerful tools that Medicine has, especially in some areas such as Vascular Surgery and Angiology, where Dr. Luis Izquierdo is a great reference. Now, he has just solved one of the most complex cases of his career thanks to the use of the Relay Pro NBS (Terumo Aortic) thoracic endoprosthesis.

How has your specialty evolved in recent years?

Every day we do less invasive procedures, navigating the arteries assisted by 3D technology, with customization of prostheses in situ, or even 100% non-invasive, as is the case with the Sonovein robot that allows treating varicose veins with therapeutic ultrasound from outside the body. In diagnostic imaging we can do everything with virtual reality and perform remote surgeries with Da Vinci or Magellan type robots.

What is the profile of the patients you meet?

Although tobacco is still the protagonist, we are seeing more and more diabetics. Diabetes is the epidemic of the 21st century. They are patients who have a more aggressive pattern of disease, involvement of smaller arteries and more complex to treat. Every day we treat older patients: now someone over 90 is no exception.

What is a stent and what types are there?

A vascular prosthesis is a device, usually a synthetic tube, used to replace the function of the artery or vein.. They are introduced by catheterization of the artery without the need for surgery. Generally, it is a metal structure, a stent or spring covered by a waterproof material or fabric, Gore-Tex, Dacron… In broad terms, there are endoprostheses to open and keep open clogged arteries and others that are used to line weak and weak areas inside. Dilated arteries, such as aneurysms.

When is a thoracic endoprosthesis used?

When there is an aneurysm or dilation of the aortic artery in its first sections from its exit from the heart until it reaches the abdomen. Or when there is a break in it.

What is currently new in this field?

The main ones are the appearance of prostheses with branches to completely replace the aortic arch and the possibility of creating prostheses tailored to the patient with a recreation of their anatomy using 3D models printed at the moment, including the arteries that go to the brain.

How does this technological revolution change your work?

It allows avoiding open surgery with extracorporeal circulation, treating cases that would be dismissed due to high surgical risk or treating impossible anatomies, with the creation of customized devices.

What advantages does it provide for the surgeon and the patient?

It gives the surgeon new weapons or tools, but the one who really takes advantage is the patient, since he converts large open surgeries with long hospital stays, transfusions, etc.. in procedures that are performed through catheterizations, with great precision and less aggressiveness.

What have they achieved thanks to this new thoracic endoprosthesis?

What it does is make it easier to treat cases that until now were impossible to carry out or that in order to do so had to assume many risks on the part of the patient.

What expectations for the future do you see on the nearest horizon?

All. Technological evolution is very rapid. Prostheses, as I say, are becoming more precise, more durable and of smaller caliber. In planning, for example, I have gone from measuring aneurysms with a compass and a ruler on X-ray plates to instantaneous planning with the computer or cell phone or using a scanner of the patient to make a reconstruction of the patient’s arteries and merge it in our operating room with the real patient and virtually navigate inside him. There are medical robots that allow vascular interventions to be performed with absolute precision and even remotely via the Internet… I do not think it will be long before 3D bioprinting of vascular tissues is applied and what are now synthetic prostheses will be biological prostheses; perhaps even made from the patient’s tissues.