Vascular & Endovascular Consensus Update
CONTROVERSIESCHALLENGESCONSENSUSVascular & EndovascularConsensus UpdateSecond nsusAcuteStrokeConsensusVenousConsensus25–28 APRIL 2017OLYMPIA GRAND LONDON UNITED .comCX Symposium@cxsymposium
2017Vascular & Endovascular Consensus UpdateCX Programme Organising BoardCo-chairmenChairmanRoger GreenhalghFrans MollMatt Thompson meritus Professor of Surgery and HeadEof Vascular Surgery Research Group atImperial College London, London, UK Professor of Vascular Surgery at UniversityP rofessor of Vascular Surgery at St George’sUniversity of London and Consultant VascularSurgeon at St George’s Vascular Institute,London, UKAorticPeripheral ArterialVenousAndrew HoldenCliff ShearmanIan FranklinA ssociate Professor of Radiology at AucklandUniversity School of Medicine and Directorof Interventional Services at Auckland CityHospital, Auckland, New Zealand Professor of Vascular Surgery at UniversityC onsultant Vascular Surgeon at LondonVascular Clinic, London, UKJanet Powell rofessor of Vascular Biology and Medicine,PImperial College London, London, UKDittmar BöcklerP rofessor of Vascular Surgery at Universityof Heidelberg and Head of Department ofVascular Surgery and Endovascular Surgeryat University Hospital Heidelberg, Heidelberg,GermanyGiovanni Torsello Professor, Head of Department of Vascularof Southampton and Vascular Surgeon in theDepartment of Vascular Surgery, UniversityHospital Southampton Foundation Trust,Southampton, UKC onsultant Vascular Surgeon at Guy’s and StThomas’ Hospital, London, UKP rofessor of Diabetic Foot Medicine andConsultant Diabetologist at King’s CollegeHospital, London, UK Professor of Vascular Surgery at ImperialThomas ZellerP rofessor of Angiology at Albert-LudwigsUniversity of Freiburg and Head of Departmentof Angiology at Universitäts – HerzzentrumFreiburg, Bad Krozingen, GermanyIris Baumgartner Professor and Head of Clinical andStéphan HaulonAndrew HoldenTilo Kölbel Professor of Vascular Surgery, Universityof Hamburg, and Vascular Surgeon at theUniversity Heart Center Hamburg, Hamburg,GermanyInternationalAdvisorsCX AbstractBoardEric ChemlaEric VerhoevenGunnar TepeJan BrunkwallKrassi IvancevPatrick PeetersNick CheshireIan Loftus, Co-chairmanRichard Gibbs, Co-chairmanPaul HayesRobert HinchliffeColin BicknellDaryll BakerRachel BellMarcus BrooksMeryl DavisSimon AshleyStephen BlackMichael EdmondsSurgery at Franziskus Hospital and Directorof the Clinic for Vascular and EndovascularSurgery at the University of Münster, Münster,GermanyP rofessor of Vascular Surgery, University ofLille, and Head of Vascular Surgery, UniversityHospital, Lille, France2Medical Center Utrecht, Utrecht, NetherlandsInterventional Angiology and Director ofVascular Research at University Hospital Bern,Bern, SwitzerlandAssociate Professor of Radiology at Auckland University School of Medicine and Directorof Interventional Services at Auckland CityHospital, Auckland, New ZealandAndrew BradburyS ampson Gamgee Professor of VascularSurgery in the College of Medical and DentalSciences at the University of Birmingham, UK,and Consultant Vascular and EndovascularSurgeon at the Heart of England NHSFoundation Trust in Birmingham, UKTrevor Cleveland Consultant Vascular Radiologist and HonorarySenior Lecturer at Sheffield Teaching HospitalsNHS Foundation Trust, Sheffield, UKFrank Vermassen Professor in Vascular and Thoracic SurgeryDepartment of Vascular Surgery at GhentUniversity Hospital, Ghent, BelgiumAlun DaviesCollege London and Consultant GeneralSurgeon at Charing Cross Hospital, London,UKAndrew Bradbury Sampson Gamgee Professor of VascularSurgery in the College of Medical and DentalSciences at the University of Birmingham, UK,and Consultant Vascular and EndovascularSurgeon at the Heart of England NHSFoundation Trust in Birmingham, UKAcute StrokeRoss NaylorH onorary Professor of Vascular Surgery atUniversity of Leicester and Consultant VascularSurgeon at Leicester Royal Infirmary, Leicester,UKMartin BrownP rofessor of Stroke Medicine, Stroke ResearchCentre, UCL Institute of Neurology andConsultant Neurologist, The National Hospitalfor Neurology & Neurosurgery, Queen Square,London, UK
2017Vascular & Endovascular Consensus UpdateWhat to expect in 20173days of AorticConsensus Update3 ays of Peripheral ArterialdConsensus Update3days of VenousConsensus UpdateDay 1 – CX Aortic Edited CasesDay 2 – Abdominal Aortic Main ProgrammeDay 3 – Thoracic Aortic Main ProgrammeDay 1 – Peripheral Arterial Main ProgrammeDay 2 – CX Live and Edited Peripheral CasesDay 3 – CX ilegx InterdisciplinaryConsensus on Severe IschaemiaDay 1 – Venous Main ProgrammeDays 2 and 3 – CX Venous WorkshopThe CX Venous Workshop will be held onGround Floor, adjacent to the Exhibition Hall.Acute StrokeConsensus UpdateHands-on experienceNEW Venous edited casesDelegates will have the opportunity toparticipate in enhanced practical courses.Both the CX Venous Workshop and theCX Vascular Access Course providestations for hands-on experience andinteraction with experts.For the first time, edited cases on venousintervention will be presented at theCX Venous Workshop (Days 2 and 3),from 9.00 to 10.00. From 10.00 to 16.00the workshop will continue with one-to-one,hands-on demonstrations.On Day 4, the Acute Stroke Consensus Updatewill explore the relationship between aorticarch manipulation and stroke, and discuss newtechniques for acute stroke intervention. It willalso seek a vertebral and carotid consensus.FacultyCX Invited Faculty will include:Gary AnselHans-Henning EcksteinNicholas InstonMarc MeissnerRobert RheeDomenico ValentiRuth BensonFabrizio FanelliMichael JaffMatthew MenardVincent RiambauJos van den BergColin BicknellMark FarberArkadius JawienRoss MilnerCelia RigaJoost van HerwaardenMartin BjörckIan FranklinMuholan KanapathyBijan ModaraiFiona RohlffsMarc van SambeekStephen BlackPeter GainesAlan KarthikesalingamRobert MorganHervé RousseauSuresh VedanthamDittmar BöcklerMauro GargiuloNarayan KarunanithyGiovanni MostiDavid RussellFrank VeithAndrew BradburyPhilipp GeisbueschNarendra Nath KhannaErin MurphyRichard SaxonMaarit VenermoMarianne BrodmannRichard GibbsTilo KölbelPatrice MwipatayiDierk ScheinertHence VerhagenMartin BrownKathleen GibsonNils KucherAndrew NicolaidesDarren SchneiderEric VerhoevenYiu-Che ChanManj GohelMichael LichtenbergKatariina NorenenJulian ScottFrank VermassenTrevor ClevelandWilliam GrayFrancesco LiistroPasha NormahaniEva SevickFabio VerziniFrank CriadoFranco GregoIan LoftusIsaac NyamekyeCliff ShearmanAnders WanhainenMartin CzernyMo HamadyLars LönnGustavo OderichMalcolm SimmsRodney WhiteFabrizio D’AbateGeorge HamiltonKevin ManiGerard O’SullivanIan SparkDean WilliamsMichael DakeStéphan HaulonSahar MansourKeith PoskittMichael SweetingThomas ZellerJosefin DammClaudine Hemel-DesnosHugh MarkusJohann Christof RaggOmke TeebkenSebastian ZerwesHector de BeaufortRobert HinchliffeTara MastracciVenkatesh RamaiahGunnar TepeWei ZhouRick de GraafAndrew HoldenCharles McCollumAlbert-Adrien RameletFabien ThaveauSebastian DebusPeter HoltVicky McDonaldMichel ReijnenMatt ThompsonJonothan EarnshawDominic HowardRichard McWilliamsTimothy ReschGiovanni Torsello3
2017Vascular & Endovascular Consensus UpdateCX 2017 Main Programme HighlightsPathways of CareThis year CX completes another cycle of Controversies, Challenges and Consensus. CX 2017 will continue to focus onEDUCATION, INNOVATION and EVIDENCE in order to reach consensus in all aspects of vascular disease management. In allsessions CX will address “Pathways of Care”, and the audience will hear presentations in all of the vascular domains on:WHETHER to intervene and benefit from itWHEN to intervene and at what thresholdINTERVENTION METHOD and evidenceFOLLOW-UP and outcomes ofinterventionPeripheral Arterial Consensus Update, including:Acute ischaemiaBelow the knee Mechanical thrombectomy and thrombolysis “Endovascular first practice” may alter equipoise for below-the-knee trials Differences following open and endovascular management of criticalischaemia using fluorescence imagingInternal iliac artery When to deploy an iliac branched device Iliac aneurysm repair – the relevance of the second sideSuperficial femoral artery Vessel preparation before drug-coated balloon use Current guidelines for drug-coated balloons Stents: The value of biometric design and the value of radial strength New trial results: Comparison of two drug-eluting stents and comparison ofdrug-eluting stent vs. drug-coated balloonDiabetic foot Point-of-care duplex ultrasound: A paradigm shift in the detection of peripheralarterial disease in diabetes? Microvascular complications of diabetes and implications to cardiovascularriskLifestyle Exercise Smoking cessationAbdominal Aortic Challenges Update, including:Screening & indicationsMethod Cardiopulmonary exercise testing predicts perioperative mortality and longterm survival in AAA patients Optimal management of men with small and medium AAA in surveillance Cardiac rehabilitation to improve life expectancy after AAA repair The consequences of performing fewer open AAA repairs Reducing errors during minimally invasive procedures for elective AAA repair First clinical experience proves that new endografts overcome the currentlimitation in treating challenging neck Competence in EVAR techniques Safety considerations with hostile neck 10–15mmThreshold Operating below AAA threshold of 5.5cm saves lives – oh, yes? Let us listento the evidence4
2017Vascular & Endovascular Consensus UpdateOutcomes and follow-upRuptured aneursyms Elective AAA repair – UK hospital data support the EVAR trial results CX Debate on annual imaging Constant checks for type I endoleak and migration Embolisation for type I endoleaks after EVAR? – Mid-term outcomes, pitfallsand patient selection Fabric degeneration and type III endoleaks remain a problem EVAR simulation for rAAA saves lives Ruptured AAA – the early benefit of EVAR is maintained out to six years, butoverall survival remains poor Challenging anatomy predicts short- and long-term mortality andcomplications after rEVAR Challenging anatomy predicts mortality and complications after EVAR forruptured AAA How involvement in the IMPROVE trial has altered practice and departmentalconsensus for open vs. endovascular strategies for repair of ruptured AAAMini-symposium on type II endoleaks Validation of a method to define patients at risk for type II endoleak, based onpreoperative CT anatomic characteristics What is the transiliac route for the embolisation of type II endoleaks postEVAR? – Technique, when to attempt it and efficacy Systematic review on treatment success for type II endoleak Direct percutaneous sac puncture an easy way to solve type II endoleaks afterEVAR Endovascular aortic repair out of instructions for use in ruptured AAAThoracic Aortic Challenges Update, including: Thoracic pathologies and different approaches for each Total endovascular aortic repairAscending aortic aneurysm Ascending aortic aneurysm remodelling for various pathologiesArch aneurysm CX Debate: Branched or fenestrated devices have superceded arch repair asfirst-line treatment Long-term feasibility data of thoracic single branched endograft in the aorticarch zones 0, 1 and 2 Anatomical challenges and TEVAR performance in the aortic archRisk of cerebral embolisation after arch procedures: The role of air embolisation in EVAR and TEVAR and strategies to prevent it The use of embolic filters to reduce the stroke risk in TEVAR Gaseous embolisation from the archJuxtarenal ESVS consensus guidelines for descending thoracic aorta management The ESVS Guidelines on the management of diseases of the mesentericarteries and veins Treatment of complex aortic pathologies using parallel grafts, snorkels andchimney graftsRadiation dose awareness in aortic interventions Total contrast-free EVAR: dream or reality? Contrast-enhanced cone beam CT for intraoperative quality assessmentduring endovascular aortic procedures Radiation exposure to operative teams – the need to reduce radiation dose infollow-up Cellular markers of radiation damage during TEVAR The use of IVUS to reduce radiationDescending aortic aneurysm CX Debate: Types A and B terms are no longer satisfactory Inflammatory aneurysm – current consensus guidelines do not apply withconnective tissue disorders Migration after TEVAR Uncomplicated chronic type B dissection revisited5
2017Vascular & Endovascular Consensus UpdateVenous Consensus Update, including:Investigations of superficial and deep venousanatomy The search for the best imaging modality is a worldwide problem CT venography and MR venography are performed in the horizontal position –Suitability for assessing venous function The place of ultrasound for deep venous assessment Value of intravascular ultrasound in venous investigation and radiationreductionAssessment and interventions of acute andestablished superficial and deep venousthrombosis Pathways of care for venous stenting interventions Treatment for acute deep venous thrombosis – Pathways of care on the use ofcatheter-directed thrombolysis and mechanical thrombectomy ATTRACT trial: Medical treatment versus intervention (catheter-directedthrombolysis or mechanical thrombectomy) Surveillance of venous stentsPelvic vein congestion and reflux Prevalence of venous reflux de novo Distinguishing pathological from natural refluxVaricose vein management Percutaneous valvuloplasty Biomatrix sclerofoam as a rival for endothermal ablation Predictors of recanalisation after acrylocyanate truncal vein treatment Improved compression techniques PressPatch device to improve working compression pressureAesthetic phlebology Optimising cosmetic outcomes for reticular veins and telangiectasis Foam sclerotherapy for reticular veins and telangiectasisLymphoedema Modern understanding of primary lymphatic dysplasias and prognosis Modern strategies for imaging in lymphoedema Surgical procedures for lymphoedemaLeg ulceration Modern guidelines for leg ulceration Pathways of care – Early Venous Reflux Ablation (EVRA)Upper limb/subclavian vein compression Conservative treatment of Paget Schrötter syndrome Treatment of subclavian vein compression/central veins occlusionsAcute Stroke Update, including:Carotid endarterectomyIntracranial intervention The decreasing numbers of patients undergoing CEA – is it risk aversion orbetter medical management? Predicting stroke risk in carotid disease duplex ultrasound criteria includingcarotid plaque volume What is wrong with current carotid guidelines and why guidelines aremisleading Cerebral micro-embolisation during endovascular aortic surgery – The casefor investigating the benefits of carotid protection devices in all endovascularpatients, and the need for a consensus on protocols Protocol for patient with stroke after an endovascular aortic arch procedure What the HERMES collaboration tells us about structuring systems of care toprovide timely treatment to acute ischaemic stroke patients Aortic arch endovascular procedures and location of stroke care The European experience with mobile stroke units The role of emergency medical service providers in improving strokepathways of care MR, CT angiography or CT perfusion – which imaging is best? General anaesthesia versus conscious sedation Stent retriever, aspiration, or both New thrombectomy technology Ongoing and upcoming trialsVertebral artery intervention Rapid interventions are essential (VIST and VAST trials) Sex and age affects the outcomes of carotid endarterectomy and carotidartery stenting The need for co-ordination of services6
2017Vascular & Endovascular Consensus UpdateCX Parallel SessionsCX missionThe Parallel Sessions of the Charing Cross Symposiumoffer attendees the opportunity to enhance skills for dailyclinical practice in the vascular and endovascular fieldwith educational and practical sessions.The Charing Cross Symposium raises vascular and endovascularcontroversies so that a world-class faculty challenges the availableevidence in order to reach a consensus after discussion with anexpert audience. This forms a three-year cycle – in 2017, the CXprogramme is designed to reach consensus after discussion.CX Aortic Edited Cases CX programme and formatCX Peripheral Live and Edited Cases All Charing Cross Symposia are distinguished by a unique andlogical programme, which focuses on identifying evidence foroptimal vascular disease management from head to toe, catering forall vascular specialists.CX Venous Workshop CX Vascular Access CourseCX Abstract and Poster Sessions Debate and emphasis on interaction with an expert audience arekey aspects of the CX style. Education, Innovation and Evidenceare CX core values.CX ilegx Interdisciplinary Consensus on SevereIschaemia Short presentations and time-keeping are key characteristics ofthe CX sessions; these enable the right time for comments andquestions by the audience.CX Innovation Showcase CX Meets Latin America At the sessions, there is a chairman who monitors time, encouragesaudience and speaker interaction and conducts the discussion;there is also a moderator who assists the chair with questions toand from the audience.CX Paediatric Issues and Congenital VascularMalformationsLINC@CX How to register for CX 2017CX 4-DAY RATEEarly bird*Standard rateCX 1-DAY RATELate/onsite registration**Early bird*Standard rateLate/onsite registration**Full registration 695 795 895 295 345 385Junior doctorregistration 345 395 445 150 180 195 145 175 195 75 95 105Vascular technologist/nurseNote: Includes symposium bookNote: Excludes symposium bookCX VASCULAR ACCESS 3-DAY COURSEEarly bird*Doctor rateNurse rateStandard rate 295 75CX ACUTE STROKE CONSENSUS – FRIDAYLate/onsite registration** 350 95 395 105Note: I ncludes CX Vascular Access activities on the Wednesday, Thursday &Friday only. Excludes entry to other CX events and symposium bookStep 1: Visit www.cxsymposium.com to complete online orto download printable registration/hotel forms.Step 2: Choose your registration rate.Step 3: Make your payment.Early bird* 95Standard rateLate/onsite registration** 115 125Note: Friday only. Excludes delegate bag and symposium bookStep 4: W e will send you confirmation of your registrationwithin 48hrs.Step 5: V isit www.cxsymposium.com/cxhotels to bookyour hotel.Step 6: We will send you an email with your unique barcode10 days before the event for badge collection.Terms * Early bird rates are valid for registrations receivedbefore midnight on 26th February 2017. ** Late/onsite registration applies after Friday21st April 2017. Rates are inclusive of VAT at 20%. Credit card payments received via mail ortelephone will be processed in GBP anddebited at the current rate of exchange. Cancellation policy: Cancellation prior to24th March 2017 will be subject to a 20%administration charge. We regret that refundsafter this date will not be available. Junior doctors should provide letter ofauthorisation. Registrations will not be confirmed unless wereceive the full contact details of the delegate,including the direct email address. Industry participants should register at the fullregistration rate. All registrations except the CX VascularAccess 3-day course allow entry to all mainand parallel events.7
Key dates26 February 201725–28 April 2017Early bird registration ends:Save the CX 2017 dates:EDUCATIONINNOVATIONGeneral enquiriesEVIDENCEExhibitor informationCharing Cross SymposiumShilpa Suthar526 Fulham Road,Tel: 44 (0) 20 7736 8788London SW6 5NR, United KingdomFax: 44 (0) 20 7736 8283Tel: 44 (0) 20 7736 8788Email: shilpa@bibamedical.comFax: 44 (0) 20 7736 8283Email: info@cxsymposium.com
consensus for open vs. endovascular strategies for repair of ruptured AAA Endovascular aortic repair out of instructions for use in ruptured AAA Thoracic Aortic Challenges Update, including: Thoracic pathologies and different approaches for each Total endovascular aortic repair Ascending aortic aneurysm
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Cost-effectiveness of Elective Endovascular Aneurysm Repair Versus Open Surgical Repair of Abdominal Aortic Aneurysms Burgers, L.T. et al. European Journal of Vascular and Endovascular Surgery , Volume 52 , Issue 1 , 29 - 40 If willingness to pay thresholds of 20,000 or 80,000 per QALY gained are used,37 EVAR has a high probability
Table 1: In-hospital outcomes of endovascular versus open TAAA repair before and after propensity score matching Pre-propensity score matching Post-propensity score matching Open Endovascular Open Endovascular Outcome N 361 N 303 p-value N 241 N 241 p-value Death, n (%) 64 (17.7) 31 (10.2) 0.01 42 (17.4) 26 (10.8) 0.04
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