Streamliner multilayer flow modulator for thoracoabdominal aortic pathologies: Recommendations for revision of indications and contraindications for use

The Streamliner Aortic Multilayer flow modulator (SMFM) proposes a physiological solution rather than a physical barrier for treatment of the aortic wall through its four-dimensional mechanism. The purpose of this review is to evaluate the current aortic SMFM indications for use and construct new clinical recommendations, based on outcomes from a global registry and evidence gathered from published literature. The MFM Global Registry was formed for the purpose of understanding the outcomes of thoracoabdominal aortic pathology patients managed by the SMFM. Our published data and prospective analysis have confirmed the superiority of the SMFM in managing aortic dissection, saccular aneurysms, and patients who had a previous aortic intervention, regardless of the method of intervention. Conversely, thoracoabdominal aortic aneurysms (TAAAs) with a diameter >6.5 cm, aortas lined with eccentric thrombus (ie, shaggy aortas), and patients with a history of or active malignancy or myeloproliferative disorders, are an absolute contraindication to the use of this flow-laminating technology. To date, poor outcomes from the MFM Global Registry are almost invariably explained by a lack of appreciation of the device's limitations and its application outside its instructions for use. Care is always required when diffusing innovation into modern clinical practice, particularly when the innovation is a complete departure from existing technologies. We must be adaptable and flexible, and change our practice according to the dictates of scientific evidence. This practice includes outright restriction to firm contraindications and widespread use in indicated complex pathologies.