Guidelines for Credentialing of Practitioners to Perform Endovascular Stent-Grafting of the Thoracic Aorta

Abstract

Recent innovations in endovascular grafting technologyhave made the endovascular treatment of thoracic aorticaneurysm, dissection, and other thoracic aortic diseases aviable alternative to open surgical repair. Like many newsurgical procedures, thoracic endovascular stent-graftingpresents challenges to physicians who care for patientswith thoracic aortic disease. When new surgical proce-dures are introduced, the pressure for rapid adoption canlead to deviations from the fundamental principles ofphysician education and training and from the estab-lished indications for operative intervention. These devi-ations may compromise the quality and safety of patientcare.As with any surgical procedure, appropriate manage-ment of the specific underlying disease process involvesseveral distinct but interrelated components. First and fore-most, the involved physicians must possess a broad under-standing of the disease entity. Second, they must possessknowledge of, and expertise in, all of the available thera-peutic options, including, but not limited to, the new tech-nique that is being applied. They must be able to care forthe treated patients in the post-procedural period and todeal with the potential complications of a specific therapy.Third, they must receive technique-specific training. Toenable physicians to meet these basic requirements forthoracic endovascular grafting procedures and to becomecredentialed to perform them, specific criteria for all threeof these categories must be established.