A number of advanced endograft technologies have been developed to extend the use of EVAR in patients in whom standard stent-grafts are not applicable due to unfavourable anatomical features. These include stent-grafts that preserve the iliac bifurcation, fenestrated stent-grafts for juxtarenal aortic aneurysms, side-branched stent-grafts to preserve perfusion of abdominal or thoracic aortic branches, hybrid approaches combining debranching of aorta and extra-anatomic bypass, etc. The feasibility of all of these techniques has been established and a small number of centres have begun to accumulate clinical experience. It can be anticipated that many more vascular centres will adopt these techniques in the near future . But as in the early days of EVAR, enthusiasm and optimism for these techniques needs to be tempered by recognition of potential risks, the extent of which is largely unknown. Apart from the advanced techniques, advances in the treatment of thoracic aortic pathology using standard stent-graft techniques also have been slow to come. It is essential to continue further evaluation of standard thoracic EVAR, in addition to the aforementioned advanced techniques, with stratified analyses according to the type of pathology treated.
Despite the obvious need for methodical and rigorous evaluation of various aspects of these techniques, it is difficult to achieve this. These techniques are being applied to a relatively small number of patients in each of the centres using them and it takes a long time to establish a substantial cohort even in the busiest of the centres. In several ways, the issues facing further evaluation and development of these techniques today are the same as those facing standard EVAR, a decade ago. There is a strong case for physicians to create a joint venture of clinical research in order to develop a database, that is large enough to allow conclusions to be drawn within a timeframe that will support efficient development and evaluation of these techniques. It is the aim of GLOBAL collaborators on Advanced Stent-graft Techniques for Aneurysm Repair (GLOBALSTAR) project to serve this role.The GLOBLSTAR project is a network of collaborators and all physicians with established or developing experience of advanced and thoracic EVAR techniques are welcome to join. Collaborators are expected to propose and lead specific studies. The project is overseen by the international advisory board, whose role is to, 1) propose / approve registry protocols, 2) oversee data collection, data-protection and ethical responsibilities, 3) develop and verify reports and publications, 4) ensure freedom from conflict of interest and bias, and oversee financial arrangements, and also 5) approve applications from new participating centres. The project is also supported by registry advisors, a data manger and a health scientist. The principal investigator is responsible for the day-to-day functioning of the electronic web-based registry and the core laboratory under the supervision of the international advisory board.
The first meeting of the International Advisory Board took place at the Charing Cross symposium, London on 15 April 2007. Membership of the International Advisory Board is as follows: John Brennan, Liverpool, UK; St©phan Haulon, Lille, France; Krassi Ivancev, Malm̦, Sweden; Barry Katzen, Miami, USA; Robert Laheij, Nijmegan, The Netherlands (Health Scientist); Alan Lumsden, Houston, USA (Project Director – America); Richard McWilliams, Liverpool, UK; Christoph Nienaber, Rostock, Germany; Matthew Thompson, London, UK (Publications & Presentations Director); Eric Verhoeven, Groningen, The Netherlands (Project Director – Europe); and Rao Vallabhaneni, Liverpool, UK (Principal Investigator). The project Consultants are Jacob Buth, Eindhoven, The Netherlands and Peter Harris, UK.
The registry is expected to come on line in November 2007. This is an exciting and ambitious project, success of which depends upon the enthusiasm with which the physicians and the industry embrace it.