Endothelial cell granted superhero status in invited research presentation

“The endothelial cell is the superhero of the vascular system,” Kathryn L. Howe, MD, PhD, FRSCS, a vascular surgeonscientist at the University of Toronto in Toronto, Canada, argued yesterday in Plenary Session 2.

Howe put forward the case that there is a parallel between Superman and the superpowers that can be seen of the endothelial cell. Both, she averred, are considered guardians, that are “more than they appear,” and have crucial roles in the sense that they can respond to their environment and shift identity.

Just like Superman, however, Howe pointed out that endothelial cells have a kryptonite. Smoking, sleep habits, diet, sedentary activity, diabetes, obesity, dyslipidemia and hypertension are “all factors that undermine the power of the endothelial cell,” the presenter stressed.

So, what can vascular surgeons do? To this question, Howe had a clear answer: “We can deliver exceptional vascular care by promoting endothelial health for all.”

IN A PROSPECTIVE, NON-RANDOMIZED STUDY, RESEARCHERS FOUND THAT A total transfemoral approach was associated with lower rates of cerebrovascular events and improved outcomes compared to an upper extremity approach during fenestrated/branched endovascular aneurysm repair (F/BEVAR).

Thomas Mesnard, MD, research fellow at the University of Texas Health Science Center at Houston, is due to share this finding with the VAM audience this morning (11:45–11:52 a.m.) during Plenary Session 4, which takes place in Potomac A/B.

The authors detail in their abstract that this study was conducted over the course of nine years, from 2013–2022, and included 541 patients (70% male; mean age, 74±8 years) treated with F/BEVAR. They specify that an upper extremity approach was used in 366 (68%) patients and transfemoral access in 177 (33%) patients.

Mesnard will report that the use of a transfemoral approach was associated with lower fluoroscopy time (p=0.001), lower operative time (p<0.001), similar cumulative air kerma (p=0.2), and similar technical success (p=0.96) as compared to an upper extremity approach. Mortality occurred in 1% of all patients, with no significant difference between groups (p=0.67).

Furthermore, he will share that patients treated by an upper extremity approach had significantly higher rates of major adverse events (18% vs. 8%, p=0.006) and more cerebrovascular events (3% vs. 0%, p=0.035).

Mesnard will present these findings on behalf of Gustavo S. Oderich, MD, professor of surgery and chair of vascular and endovascular surgery at the University of Texas Health Science Center at Houston, and colleagues.

Speaking to VS@VAM ahead of the presentation, Oderich comment ed on what procedures in this space might look like in the future: “Transfemoral access allowed us to reduce the risk of stroke and complications. This has been possible with the development of steerable sheaths. It is likely that, with the introduction of smallerprofile stents and better sheaths, the procedure will be simplified even further.”