CHARING CROSS SPECIAL EDITION March 2016 2016 Vascular & Endovascular Challenges Update Tackling the challenges in the vascular and endovascular arena
Peripheral Acute Aortic Venous Arterial Stroke Challenges Challenges Challenges Challenges
Halfway through its Controversies, Challenges and Consensus allow the audience to interact with the Challenges Programme—new as of cycle, the Charing Cross Symposium will examine this year the speakers and panel at every stage. 2016—will make its debut. The half-day numerous and varied challenges currently facing the vascular This year, the CX Venous Challenges Programme is being introduced following and endovascular field. The Symposium will be held from 26 to 29 Main Programme will, for the first time, the realisation that a number of strokes April 2016 at Olympia Grand, London, UK. take place on the Symposium’s opening are caused by interventions in the aorta day, exploring the use of various technolo- and manipulations in the arch. his year’s Peripheral Arterial aortic aneurysm trial to be conducted, gies and techniques for the treatment of The purpose of the Acute Stroke Chal- Challenges session will centre and the first to reach fifteen-year follow- superficial and deep venous disease with lenges Main Programme is to encourage around management of the up. The 10-year data, presented at CX emphasis on the latest evidence of when a multidisciplinary approach, such that superficialT femoral artery. Treatment 2010, demonstrated no significant dif- and in which patients they should be used. unwanted emboli to the brain can be man- strategies, varying depending on lesion ferences between endovascular and open The topics for discussion will include aged by clot retrieval, and the optimisation type and length, will be analysed, with repair in terms of mortality. acute deep vein thrombosis and deep vein of referral so that stroke patients reach the a special emphasis on the status and Another first-time presentation in the stenting challenges, proximal deep venous best hands as fast as possible. expectations of drug-coated balloons, Abdominal Aortic Main Programme will obstruction and pelvic vein reflux chal- The new CX Vascular Access drug-eluting stents, new biomimetic and be an Individual Patient Data meta- lenges. A new session on lymphoedema Course will be held on the second, third swirling flow stents and stent grafts. analysis of the EVAR vs. open repair challenges will precede discussions on and fourth days of the Symposium. The Delegates will be able to learn new randomised controlled trials—EVAR 1, superficial venous challenges. Course will provide both experts and those techniques for femoropopliteal lesion DREAM, OVER and ACE. The ever-popular CX Venous new to the field with invaluable insights treatment through attending the CX On the third day, the Main Programme Workshop will run throughout days into the challenges currently facing haemo- Peripheral Arterial Live Cases, which will be dedicated to challenges in the two and three, consisting of one-to-one dialysis vascular access, and the methods returns after its successful 2015 debut. treatment of thoracic aortic diseases, with demonstrations by world-leading experts. used to overcome them. The three-day This year’s live cases will be broadcast an emphasis on type B dissections. The Workshop will expand on the Course will bring together world experts to from Münster, Germany. Also on the third day, the CX Aortic Ed- technical aspects of the key superficial cover current practice and remaining chal- The main talking point of the 2016 Ab- ited Cases will explore the application of and deep venous topics discussed in the lenges. It will be made up of a masterclass dominal Aortic Challenges session is the different techniques in complex thoracic CX Venous Main Programme. This year, on ischaemic steal syndrome, a practical presentation—for the first time—of15- aortic and abdominal aortic procedures. a new section on aesthetic phlebology skills course and an abstract presentation year follow-up data from the Endovas- The format will be that of short case will also be included in the workshop. day, immersing delegates in the most im- cular Aneurysm Repair (EVAR) 1 Trial, presentations followed by imaging and On the final day of this year’s portant issues and innovation in haemodi- the first EVAR vs. open repair abdominal indications for the procedure, and will Symposium, the Acute Stroke alysis vascular access medicine.
VascularNews.com Facebook.com/VascularNews @VascularNews VN App 2 Charing Cross Symposium March 2016 Management of the superficial femoral artery Delegates to learn techniques for femoropopliteal at the centre of the discussions at CX lesions with the CX live-case method
26 APRIL 2016 topics are related 27 APRIL 2016 edited cases will Day UPPER MAIN to the outcome Day LOWER MAIN also be presented. AUDITORIUM of drug-eluting AUDITORIUM “Our main aim is 1 technologies in 2 to provide highly The management of peripheral inter- Following the successful educational cases. the superficial femoral artery will be at ventions. More first year of the CX Peripheral Arterial During the session, the centre of the discussions at the CX than 20 years after Live Cases, CX 2016 will continue to we will discuss Peripheral Arterial Challenges Day of the establishing drug- Thomas Zeller offer delegates the opportunity to expand indications and Charing Cross Symposium 2016 (Tuesday eluting stents as the discussion of key topics from the CX reasons for us- Giovanni Torsello 26 April). Treatment strategies, depending a first-line strategy in coronary interven- Peripheral Arterial Main Programme by ing a particular on lesion type and length, will be analysed tions, drug-eluting stents and drug-coated demonstrating techniques of how device, we will present specific fea- and there will be special emphasis on balloons are becoming estab- to achieve best results in tures and characteristics of the materi- the status and expectations with different lished for femoropopliteal femoropopliteal le- als and we will demonstrate technical modalities: drug-coated balloons, drug- interventions. Drug- sions through the CX tips and tricks to ensure a safe and eluting stents, new stents (swirling flow coated balloons are live-case method. effective intervention,” said Bisdas. and biomimetic stents) and stent grafts. attractive alternatives This year, live The cases will be divided into two There is high expectation of what can to stent based (bare cases will be different parts. In the first part, differ- be achieved by drug-coated balloons, yet metal and drug- Peripheral transmitted ent techniques supporting the concept there is healthy scepticism on how durable eluting) treatment from Münster, of “leaving nothing behind” will be they will be for longer lesions. “It may take strategies, at least in Arterial Germany, with demonstrated. These include drug-coated two to three years before we know for sure less severe calcified Arne Schwindt balloons in challenging long occlusions, how the drug-coated balloon compares lesions, whereas Challenges and Theodosios atherectomy and scoring balloons. In with stents particularly for longer lesions,” drug-eluting stents Bisdas as main the second part, the concept of “leaving says Roger Greenhalgh, chairman of the show beneficial clinical operators. Giovanni something in” will be presented. During CX Programme Organising Board. long-term results over Torsello, Thomas these cases, the delegates will have the He continues, “Stents are used more bare metal stents. Interest- Zeller, Iris Baumgartner opportunity to view the deployment of commonly for longer lesions and better ing presentations will include and Michael Jaff will lead drug-eluting stents, biomimetic stents and results are sought by engaging swirl- analyses of specific restenosis patterns audience participation in London stent grafts. Finally, a case of percutane- ing flow or stents with strong radial following drug-eluting stent angioplasty. and try to shed light on why a technique ous transluminal rotational thrombectomy strength. Data on these technologies will is chosen for a particular situation. Some will be presented. be discussed. Additionally, the value of What do you think are the drug-eluting stents has been demonstrated biggest challenges physi- with five-year data and now newer scaf- cians are facing treating CX ilegx Collaboration Day addresses folds are available. All current options will peripheral arterial disease? be explored at Charing Cross 2016.” In general the biggest challenge in proactive approach to treating the diabetic foot Data on other technologies (atherectomy, some countries is that new and effec- sequential stents and single long stents), tive technologies such as drug-coated 28 APRIL 2016 which are being used in the treatment of balloons and drug-eluting stents are Day PILLAR HALL LEARNING CENTRE long lesions, will also be discussed. not adequately reimbursed, and this Delegates at CX 2016 will also hear new limits their more liberal clinical use 3 With the aim of promoting endovascular procedures, open vascular data on the IN.PACT drug-coated balloon withholding effective treatment op- the best possible care of the surgery, urgent surgical debridement and two-year results in women and diabetics, tions for a large number of patients. ischaemic lower limb to reduce the num- aggressive treatment of infection. The data from IN.PACT Global in total occlu- The most relevant technical challenge ber of major amputations, the CX ilegx clinic is operated by an interdisciplinary sions, outcomes from the German cohort is the treatment of severely calcified Collaboration Day will offer delegates an team comprising surgeon, podiatrist, nurse, in the LEVANT 2 study of the Lutonix lesions. Some potential solutions will overview of the latest treatment strate- orthotist, radiologist and diabetologist. drug-coated balloon, and an interim analysis be discussed during the main ses- gies, particularly in patients with diabetes, Revascularisation strategies will also be of the ILLUMENATE Global study sion of the peripheral programme. one of the main causes of amputations. presented with updates on the BASIL-2 with the Stellarex drug-coated balloon. This year’s ilegx course will start and 3 trials and BEST-CLI trial, and this Concerns regarding in-stent restenosis What are the main chal- with a symposium on diabetic will be followed by the session will be addressed with a specific mini-sym- lenges around the use of vascular disease. Diabetes “To stent or not to stent—that posium on this subject, which will explore drug-coated balloons in the has reached epidemic is the question”. various treatment strategies including drug- SFA and their durability? proportions and with it The ilegx initiative, coated balloons, stent grafts, laser debulking The main challenge for drug-coated has come a growing launched in 2008, was and covered stents and angioplasty or a balloons is calcium due to the vessel resist- number of complex created in response to combination of some of these technologies. ance which results in early vessel recoil. If lower limb problems the increasing number More serious chronic ischaemia is associ- drug uptake is negatively affected is still including periph- of lower limb amputa- ated with below-the-knee arterial pathology unknown. Vessel preparation—either using eral arterial disease, tions which are mostly and for the first time at Charing Cross there plaque modulation or plaque removal— which is often accom- due to type II diabetes. will be a mini-symposium on wound heal- might be a method to improve drug-coated panied by a peripheral ilegx is a collaboration ing. “This mini-symposium will investigate balloon effectiveness in calcified lesions neuropathy. of like-minded health whether healing is entirely a matter of but this also increases treatment costs. The programme will also professionals, patients and control of diabetes and revascularisation include a session on the King’s care workers who share the view or if there are methods of encouraging Is there a consensus in College Hospital open access vascu- that too many legs are amputated and healing, which relate to none of the estab- relation to drug-coated lar diabetic foot care pathway. Michael many of these are completely unnecessary. lished accepted criteria such as increasing balloons vs. stents? Edmonds, course director, explains that it The ilegx mission is to attract attention blood flow,” comments Greenhalgh. No, there is no consensus yet. The provides open rapid access to accelerate and draw awareness to the need for an im- Vascular News spoke to Thomas interventional community is split into urgent assessment and to proceed quickly provement in healthcare in order to lower Zeller, Bad Krozingen, Germany, about stent believers, in particular in France, to state-of-the-art interventions, including unnecessary major amputation of legs. the highlights of this year’s CX Pe- where drug-coated balloons are not ripheral Arterial Main Programme. reimbursed, and a school of physi- cians who believe more in a strategy The CX Peripheral Arterial Abstract Presentation Sessions What are the most interesting of leaving nothing behind favouring Day will take place on Wednesday 27 April in the London Room, topics in the CX 2016 Periph- drug-coated balloons and atherec- and in the morning of Friday 29 April in the Lower Main eral Arterial Main Programme? tomy. In the end, cost-effectiveness 4 Auditorium. In my opinion, the most interesting will drive the choice of therapy.
4 Charing Cross Symposium March 2016 Mini-symposium explores false lumen CX Abstract Presentation Sessions challenges in acute and chronic type The first day of the CX Abstract Presentation Sessions Day (Tuesday 26 April) will focus on Aortic topics. In the morn- B dissection ing, Thoracic Aortic abstracts will be presented in the Lon- 1 don Room Learning Centre, and a dedicated session on 28 APRIL 2016 Abdominal Aortic abstracts will be held in the afternoon. Day UPPER MAIN AUDITORIUM
3 It is accepted that the Great Debate: “In chronic type the prognosis and B dissection, there is no place for outcomes of type B dissection are false lumen embolisation.” Peter more favourable if the false lumen Mossop (Melbourne, Australia) and is thrombosed. According to Roger Jonathan Sobocinski (Lille, France) Greenhalgh, chairman of the CX favour intervention in the true lumen Longest follow-up Programme Organising and they will be opposed by Tilo Board, this has been Kölbel (Hamburg, Germany) and taken by some Fabrizio Fanelli (Rome, Italy) who for EVAR to be vascular specialists are in favour of embolisation of to imply that the false lumen to thrombose it. the false lumen “The management of type B presented for the should be dissection has lingered with us for Aortic embolised, about five years. It will be interesting if it is not to see what the audience makes of first time at CX 2016 Challenges thrombosed, and this,” comments Greenhalgh. intervention will Another challenge when treating 27 APRIL 2016 provide a better thoracic aortic disease is the risk Day UPPER MAIN AUDITORIUM prognosis. “This is of operative death and spinal cord a very controversial ischaemia, and a session will be 2 Fifteen-year follow-up endovascular aneurysm area,” he says; dedicated to examining preventive of the Endovascular repair against open repair therefore, CX will hold a strategies. A mini-symposium will Aneurysm Repair (EVAR) 1 Trial for abdominal aortic aneurysms, mini-symposium on the topic. discuss radiation damage to the will be presented for the first time according to Greenhalgh. The mini-symposium, which is part pioneer endovascular operators, at CX 2016. The EVAR 1 Trial The meta-analysis of the four of the Thoracic Aortic Aneurysm and this will be followed by a was the first EVAR vs. open repair trials involves merging the data over Challenges Day, will conclude with session on juxta-renal challenges. abdominal aortic aneurysm trial the years of follow-up. “Putting to be conducted and is the first to the patient data from the four trials reach 15 years of follow-up. together increases the power for CX Aortic Edited Cases “This is certainly one of the key analysis and key lessons are learned topics to be from this study,” 28 APRIL 2016 presented at the comments LOWER MAIN AUDITORIUM CX Abdominal Greenhalgh, Aortic Aneurysm principal Challenges Day investigator of (Wednesday, the IPD meta- 27 April) of analysis. CX 2016,” The data from says Roger Roger Greenhalgh Jan Blankensteijn the EVAR 1 Greenhalgh, Trial (Roger chairman of the Greenhalgh), CX Programme DREAM (Jan Organising Blankensteijn), Board. ACE (Jean- The last Pierre EVAR 1 Trial Becquemin) follow-up—the and OVER 10-year follow- Jean-Pierre Frank Lederle (Frank Lederle) up—presented Becquemin were merged at at CX 2010 Imperial College in London, UK, and and published in The New England are being analysed at the University Journal of Medicine, demonstrated of Cambridge Statistical Unit. The CX Aortic Edited Cases will be a thoracic proximal scallop, and no significant differences between The Programme will also include used to explore the application of an aneurysm case treated with the endovascular aneurysm repair and a session on the relationship different techniques in complex thoracic Zenith Alpha Thoracic endograft. The open repair in terms of mortality. between lifestyle and abdominal aortic and abdominal aortic procedures abdominal session will include cases “This extra follow-up has been aortic aneurysm growth, discussing to achieve the best outcome for patients. with the EVO Endurant next generation performed in order to see what factors, including stress, that can The format includes short patient low-profile device, preoperative intent happened to that result out to 15 lead to aneurysm enlargement presentations, imaging and indications of use of the EndoAnchor for a short years. It is very important to know and eventual rupture. for the procedure, and allows the neck, the Incraft endograft, the Zenith how the methods have done in the The presenters and panel will also audience to question at every stage. Alpha Abdominal, EVAS with the Nellix long term,” notes Greenhalgh. look at the difficulties of population This year’s thoracic session will device, a case of infection control with Another highlight of the Abdominal screening projects, which remain a include cases with the TAG Thoracic open repair, and a case using Onyx Aortic Main Programme will be challenge for public health systems. Branch Endoprosthesis for the arch, embolisation for type II endoleaks. the presentation, for the first time, The Aortic Challenges Programme of an Individual Patient Data (IPD) will include the Great Debate event, meta-analysis of the EVAR vs. in which four expert speakers will One of the CX Abstract Presentation Sessions taking place open repair randomised controlled discuss the threshold for abdominal Day on the morning of Friday 29 April will include Aortic ab- trials—EVAR 1, DREAM, OVER aortic aneurysm intervention, and stracts in the Lower Main Auditorium. and ACE. The research will show whether it should be settled by 4 the “highest level of evidence” of randomised controlled trials. March 2016 Charing Cross Symposium 5 CX Venous Challenges session to Experience venous technologies and explore when to use and when not to use techniques in the CX Venous Workshop technologies in venous disease treatment 27 APRIL AND 28 APRIL 2016 Days GALLERY 26 APRIL 2016 Day LOWER MAIN AUDITORIUM 2-3 The CX Venous Workshop a good cosmetic result every time treating consists of one-to-one thread veins in discerning patients can be 1 For the first time, the most interesting areas are developments demonstrations by world-leading experts the hardest part of phlebological practice.” CX Venous Challenges in ageing clot so we can better select and expands on the technical aspects of He continues, “We are bringing some Main Programme will take place on the patients for lysis. In addition, there are a key superficial and deep venous topics sclerotherapy techniques to expand the first day of the Symposium. The Venous number of areas of considerable debate discussed in the CX Venous Challenges aesthetic side rather than truncal venous Main Programme will be comple- principally around the concept of treat- Main Programme. This year, a new reflux. Two new laser stations using lasers mented by the CX Venous Workshop, ment of haemorrhoids with embolisation, section on aesthetic phlebology will in different ways will also be included.” which will run on days two and three. which need careful discussion.” be included in the workshop. Over two days, the workshop will “This new structure runs very nicely for Mark Whiteley (Guildford, Franklin comments: offer delegates open access to attend delegates who will have the opportunity UK), another member “The venous world various training stations at any time. to continue the discussion of the subjects of the CX Programme encompasses a wide Speaking on the additional highlights of this and techniques learned on the first day, Organising Board, variety of issues year’s workshop, Franklin says: “In 2016, on the second and third days in the CX considers that one of ranging from the CX Venous Workshop is not so much Venous Workshop, in small groups and the most interesting acute deep vein about new kit and new devices it is more face to face, with world-leading experts topics for discus- Venous thrombosis to about providing a better understanding of who will provide practical sessions on sion in the Venous severe chronic when to use and when not to use them and superficial and deep venous interventions,” Main Programme Challenges post thrombotic where they fit in the treatment of patients. says Ian Franklin (London, UK), member is the investigation syndrome and The ethos of the CX Venous Workshop is of the CX Programme Organising Board. and treatment of varicose veins but trying to create a balance bringing together This year, the CX Venous Challenges pelvic veins and the there is also a practice everything that has a phlebological interest. Main Programme will explore the use associated deep veins. He in phlebology which is We try to be as inclusive as possible for of various technologies and techniques says: “Now, proven to be related to aesthetics. Getting individual and personalised practice.” for the treatment of superficial and deep associated with leg varicose veins venous disease, with emphasis on the in one in seven women, pelvic venous latest evidence of when and in which reflux should interest anyone practising patients they should be used. Franklin varicose vein surgery. However, pushing notes: “This year we are trying to focus not the envelope further, are Previn Diwakar only on the techniques but also on when (London, UK) presenting pelvic vein to use and when not to use them. We also reflux in males and David Beckett (Poole, want to encourage more discussion about UK), suggesting haemorrhoids are part which patients are the most appropriate of the pelvic venous reflux picture.” for which technology and technique.” Franklin, Black and Whiteley agree The topics for discussion will include that the new section on lymphoedema acute deep vein thrombosis and deep vein challenges is a great addition to the Ve- stenting challenges, followed by proxi- nous Programme in 2016. Alun Davies mal deep venous obstruction and pelvic (London, UK), member of the CX vein reflux challenges. A new session on Programme Organising Board, com- lymphoedema challenges will precede dis- ments: “Lymphoedema is one of the Hands-on learning at the CX Venous Workshop cussions on superficial venous challenges. Cinderella subjects of vascular disease. Franklin says that delegates will learn A large number of patients suffer from “Long-term data needed for deep venous a more integrated approach to venous this as a primary condition or secondary disease treatment. He notes: “There used to treatments. This area needs improve- disease treatment” to be a split between superficial venous ment in defining the disease process and issues and deep venous issues, without the evaluation of new technologies to deal Stephen Black (London, UK), member as developments in our understanding of understanding that there is a huge overlap. with the symptoms suffered by patients.” of the CX Programme Organising Board, intravascular ultrasound and other adjunctive There are patients with symptoms, who we Franklin adds: “In the past, lymphoe- speaks about the current challenges in the techniques. I think we will see a big focus on have previously treated for superficial vein dema was probably neglected because treatment of deep venous disease, key lysis techniques in the next year as well as the issues and in fact they had an underly- people thought that there was not much developments in the field, and factors entry of new stents into the market. ing disease, which we never appreciated. that could be done about it. Now there are influencing outcomes in venous stenting. As data emerge for stenting in chronic As imaging and stenting techniques some quite exciting new developments, patients we have the challenge of dealing improve we now have potential to get which may change that perception. Some What are the major challenges with both early stent occlusion and later much better results in these patients.” of them are variations of existing treat- treating deep venous disease? restenosis. Very rarely this is a problem Stephen Black (London, UK), also a ment and some are new techniques. We We need to improve our data on deep venous with the stent—apart from technical issues member of the will explore those disease treatment, particularly regarding long- usually relating to poor deployment—so CX Programme developments at term outcomes and patient selection. Patency our challenge is to understand the factors Organising Board, Charing Cross.” alone is not good enough. We also need to impacting thrombus formation and flow in adds: “This year The CX Venous focus on the significance of the problems that stents. Particularly, flow is hard to measure we will see data to Abstract Presenta- post-thrombotic syndrome causes in quality of before and after stent treatment and ap- be presented on the tions are also an life and work out how to best represent this. pears to be a very significant component of first investigational important addition why stents fail. Managing clotting is also device exemption to the Venous Are there any key developments complex. I am sure we will see advances studies conducted Ian Franklin Stephen Black Programme. in the deep venous field? in stent design but we need to remember for the dedicated Black comments: Yes. We are seeing for the first time data that the stent is only one component of venous stents as “The abstracts presented on the new venous stents as well successful treatment. well as a number complement the of new develop- Main Programme ments in clot lysis and should allow The CX Venous Abstract Presentations will take place in the and mechanical for stimulating Day morning of Friday 29 April in the London Room Learning thrombectomy. I discussion of a Centre. believe, however, number of con- 4 that some of the Mark Whiteley Alun Davies troversial areas.” 6 Charing Cross Symposium March 2016
The CX Acute Stroke Abstract Presentations Day will take place in the afternoon of Thursday 28 Insights into acute 3 April in the Olympia Room Learning Centre. stroke challenges
Ross Naylor (Leicester, UK), member of the CX Programme Organising Board, discusses the biggest challenges of Debut of the new Acute treating acute stroke, the role of a multidisciplinary team in this setting and the highlights of the CX Acute Stroke Challenges session Stroke Challenges What do you think are the will explore the statement biggest challenges treating “Only neuroradiologists Programme acute stroke? should undertake intra-arterial Improving patient thrombectomy”; what are your 29 APRIL 2016 awareness about the views with regards to this Day UPPER MAIN AUDITORIUM need to seek urgent practice? medical advice as As with many other aspects of 4 On 29 April approach such that soon as transient endovascular care, it is more 2016, the Charing unwanted emboli Acute ischaemic attack important that our patients have Cross Symposium will hold to the brain can or stroke-like rapid access to a trained and Acute Stroke Challenges, a new be managed by Stroke symptoms experienced practitioner, rather educational, multidisciplinary clot retrieval, and happen; than the specialty badge he or she Programme directed by Ross to encourage the Challenges persuading wears. Rotas for providing acute Naylor (Leicester, UK) and optimisation of health systems intracranial thrombus retrieval will Martin Brown (London, UK). referral so that stroke of the importance be quite onerous and will require Discussing the rationale for patients reach the best of setting up 24-hour service delivery. The more incorporating this session at hands as fast as possible. dedicated daily qualified and experienced people this year’s Symposium, Roger The latest technology to cerebrovascular clinics that can join these rotas the better. Greenhalgh, chairman of the CX arise has been the stent retriever, for ensuring the rapid treatment Programme Organising Board, says: now in use in acute stroke units. of transient ischaemic attack patients What is the rationale for the “The realisation that a number of The Programme will explore and convincing hospitals of the need addition of the CX Acute strokes are caused by interventions different aspects of intracranial to have 24/7 access to interventional Stroke Challenges at the 2016 in the aorta and manipulations clot retrieval, including patient services who can perform intracranial Symposium? in the arch has led to the birth of selection and current therapies, thrombectomy and/or for ensuring that For too long, stroke has been the the new Acute Stroke Challenges and an overview of the main trials triage systems exist to enable rapid ‘poor relation’ when compared with Programme, a natural extension of in the field will be discussed. patient transfer to centres that can. the much greater emphasis placed on the Charing Cross Symposium.” The Programme will also cardiological interventions and endo- The half-day Programme introduces feature a selection of strategies What is the current role of vascular treatment of aortic patholo- a multidisciplinary approach to acute for intervention including the a multidisciplinary team in gies. Yet, there are important advances stroke challenges. This is a logical role of imaging for acute stroke treating acute stroke? happening all the time in the field of extension of the endovascular arterial patients and an algorithm of care As we move towards ultra-rapid stroke prevention and its acute treat- world as many of the cerebral emboli or “stroke workflow”, followed by treatment of patients with stroke ment, which affect a lot of medical are being triggered by catheterisation presentations on the current role (and transient ischaemic attack), it specialties. It is rare for experts from of the aortic arch associated with heart of urgent carotid endarterectomy is no longer appropriate to rely on vascular surgery, interventional radiol- valve replacement or manipulations and carotid stenting. the traditional weekly carotid/stroke ogy, neurointerventional radiology, of the great vessels. In an era when The purpose of the Acute Stroke multidisciplinary team, as most neurology and cardiology to be able the whole of the aorta can be replaced Challenges Main Programme, interventions are now carried out as to meet and participate in a dedicated by endovascular techniques, more Greenhalgh comments, “is to emergency or as semi-urgent procedures. Acute Stroke Challenges session to de- and more catheterisation of the arch encourage a multidisciplinary This will still require specialties to bate and discuss all the latest evidence of the aorta is expected, and with approach such that unwanted emboli consult and aid each other, but this will and innovations. Fortunately, CX will it, more cerebral emboli with awful to the brain can be managed by probably now be on a less rigid basis. offer that opportunity. outcomes. The purpose of the Acute clot retrieval, and to encourage The key is to develop guidelines for Stroke Challenges Main Programme the optimisation of referral so ensuring that patients have rapid access What will be covered at the and Abstract Presentation sessions that stroke patients reach the best to collaborating specialties, rather than CX Acute Stroke Challenges is to encourage a multidisciplinary hands as fast as possible.” turf wars over who should be doing session? what. There is still a lesser role for We will be covering everything from the traditional multidisciplinary team, identifying the high-risk carotid but this will be for the more complex plaque, through access to urgent semi-elective cases which do not require stenting and carotid endarterectomy emergency or urgent interventions. in the hyper-acute period after onset of symptoms, modern medical How can physicians who therapy strategies, dual antiplatelet intervene in the aorta, aortic strategies during carotid surgery, arch and carotid arteries work emergency endarterectomy for together with stroke specialists progressing stroke, the various to improve stroke rates and strategies available for intracranial outcomes? clot retrieval and a debate about who By attending the Charing Cross should be performing intracranial Symposium to see how interdisciplinary thrombectomy. The day concludes collaboration and knowledge of the with a series of talks on strategies latest technologies can help them for reducing arch embolisation avoid a potentially devastating during thoracic endovascular complication like stroke. procedures, as well as other techniques for reducing the overall A debate at the CX Acute burden of cerebral embolisation Ross Naylor Martin Brown Stroke Challenges session during various arch interventions.
8 Charing Cross Symposium March 2016 New CX Vascular Access Course
The CX Vascular Access Course will provide both experts and those new to the field with invaluable insights into the challenges currently facing haemodialysis vascular access, and the methods used to overcome them. The three-day Course will bring together world experts to cover current practice and remaining challenges. Course directors Domenico Valenti and Nicholas Inston speak about the focus of the course.
What are the current particularly when maturation failure rates challenges in the treatment are high. Adjuncts to improve primary of patients with kidney failure patency and prevent the formation of requiring vascular access? neointimal hyperplasia would be a major There are a number of significant chal- advance in the field with direct benefit to Domenico Valenti Nicholas Inston lenges. The first is timely identification patients. and referral of patients who require What new technologies will be forward to seeing at the CX access. Those patients who start dialysis What are the current challenges discussed in the course? Vascular Access Skills Course? on a CVC (line) have much lower rates in treating steal syndrome? The rapidly evolving technological Ultrasound assessment is always popular, of definitive access than those who Treatments to maintain vascular access field of vascular access encompasses and it is always good to pick up tricks have been referred to a surgeon prior patency whilst avoiding distal ischaemia diagnostic and interventional devices. from world experts. The benefit of the to dialysis initiation. Once a patient is are challenging. Preoperative prediction of World experts in the areas of imaging, skills course is that the demonstrators can referred, the most common choice of steal syndrome (or haemodialysis access- surgery and interventional radiology explain why they do something. access appears to be guideline-driven, induced distal ischaemia—HAIDI), will be assembled to discuss multiple which may not suit many patient groups. diagnosis and specific treatment are technologies such as grafts, stents and The presentation of vascular The individual tailoring of access appears again driven by poor data. Further good even non-surgical arteriovenous fistulae access abstracts is scheduled to be key to success and a pure guideline quality studies based on standardised creation. for Friday 29 April. What is based “fistula first in a distal position” is classifications are required, particularly your opinion about this year’s challenged by many experts in the field. longitudinal observational studies to On the second day (28 April), abstracts? In maintaining patency and longev- define the natural history of HAIDI and participants will take part in The volume of high quality abstracts ity in fistulae and grafts the key role of outcomes of treatment. a skills course. What are the submitted confirms a growing interest from multidisciplinary care—between dialysis benefits of having a practical both trainees and established surgeons nurses, nephrologists, surgeons and This year CX delegates will session on vascular access? in the field. Many questions still remain interventional radiologists—is becoming experience a new Vascular The addition of a hands-on course is in haemodialysis vascular access and the better appreciated and the application of Access Course, with activities intended to give delegates the ability research submitted aims to answer many technological innovations is increasing. over three days. What will to gain practical skills and be tutored of these. The session will be thought- With increased application the evidence participants learn on the first day through the many techniques involved provoking and should promote debate. base is often poor and expensive invasive of the course (27 April)? in vascular access. As it covers the techniques are difficult to compare due to By assembling a faculty of world whole spectrum of vascular access it is Wednesday 27 April lack of quality trials. experts and in conjunction with audience suitable for those new to access as well (Pillar Hall Learning The lack of any useful pharmacologi- interaction, we expect to not only cover as those with expertise. Centre), Thursday 28 April cal treatments for arteriovenous fistu- the current state-of-the-art practice in the (Exhibition Hall) and Friday lae, either at the time of creation or to area but also define the evidence gaps that Could you please highlight some 29 April (Pillar Hall Learning maintain patency, is a major concern, require further study. of the stations you are looking Centre) Innovators to showcase fresh approaches to vascular and endovascular challenges The CX Innovation Showcase provides a platform for the latest vascular and Vascular bioresorbable stent programme. endovascular technologies, and is geared towards encouraging physician-inventors to In the Innovation Showcase, budding physician- share their work with a wide range of industry experts, investors, start-up companies inventors will get the chance to hear from and interact and fellow inventors. The session will be held on Wednesday 27 April in the Olympia with experienced field leaders. Speakers will offer Room with course directors Stephen Greenhalgh and Andrew Holden. advice on a range of vital topics, including how to secure funding for a new device, how registry data he thoracic aortic section of the Showcase will can assist a device approval and common pitfalls that include new software for the measurement of physician-inventors should work to avoid. Tthe inside of the curve aortic disease (En- dologix), data on the early experience with a surgeon- Dragons’ Den 2016 modified and simplified thoracic abdominal aortic Several physician-inventors will then showcase their aneurysm device (Medtronic) and off-label use of the innovative vascular and endovascular ideas/projects Amplatzer vascular plug II (St Jude Medical) to seal to a panel of “Dragons” in the Dragons’ Den session. s m a l l c h r o n i c d i s s e c t i o n e n t r i e s i n t h e a r c h . The panel will include Bob Mitchell, Daveen In the abdominal aortic part of the programme, Chopra, Jason Field and Chas Taylor. The winner of delegates will hear about advances in in vivo the 2015 CX Innovation prize was Jeffrey Lawson fenestration technology, the latest 3D-printed (Durham, USA), for his dialysis graft technology, aortic models for FEVAR and will be given an which is designed to protect patients when their overall review of the Zenith Alpha (Cook Medical) dialysis graft needs to be cannulised with a sharp technology. needle. Commenting on the value of the Dragons’ Those attendees interested in peripheral innovation Den session, Lawson said: “It is a wonderful will hear updates on several nascent technologies, opportunity, and it is fun. It is also really good to including the Chocolate drug-coated balloon see other people’s technology making progress.” (Trireme Medical), the Everflex self-expanding stent (Freedom Trial; Medtronic), the Zilver PTX stent Wednesday 27 April – Olympia Room (ZILVERPASS trial; Cook Medical) and the Abbott Stephen Greenhalgh with 2015 winner Jeffrey Lawson Learning Centre
10 Charing Cross Symposium March 2016 CX Abstracts Sessions to showcase upcoming talents
In the CX Abstract Presentation Sessions, clinicians—both junior and senior—will present their latest research to leaders in the vascular and endovascular fields. The CX Tuesday 26 April Abstract Presentation Sessions are a platform for spotting and promoting new talent, Thoracic Aortic – London Room (morning) providing an opportunity to recognise upcoming key opinion leaders who could become Abdominal Aortic – London Room (after- part of the CX Faculty in the future. noon)
he CX Abstract Board and CX Programme the course of the Symposium. Wednesday 27 April Organising Board have selected and accepted over All abstracts selected for presentation have Peripheral Arterial – London Room T190 abstracts and nearly 30 posters to be included. been included in the CX Abstract Book. The best The Abstract Sessions have been spread across all presentation from each of the two categories Thursday 28 April four days of the Symposium and divided into themed (junior and senior) will be awarded a £1,000 prize Imaging – Olympia Room (morning) sessions: abdominal aortic aneurysm, thoracic aortic, and a diploma for best presentations. The prize Acute Stroke – Olympia Room (afternoon) venous, peripheral arterial, and acute stroke. The winners and holders of certificates of merit will be sessions will take place in the CX Learning Centres. invited to suggest a presentation topic for the 2017 Friday 29 April Two more themes—vascular access and imaging— Charing Cross Symposium Main Programme. Aortic/Peripheral – Lower Main Auditorium have been added to the Abstract Presentations, and The CX Abstract Board will be co-chaired by (morning) will take place as part of the CX Vascular Access Ian Loftus and Richard Gibbs. The other members Vascular Access – Pillar Hall (morning) Course and CX Imaging Day, respectively. of the Board are Paul Hayes, Robert Hinchliffe, Venous – London Room (morning) The selected poster presentations will be Colin Bicknell, Daryl Baker, Rachel Bell, Marcus displayed in the Exhibition Hall throughout Brooks, Meryl Davies and Simon Ashley. CX Imaging Day to highlight CX Vascular Malformations state-of-the-art technology Management The use and development of medical imaging is vital in he 2016 CX Vascular Malfor- encouraging the continued success of endovascular mations Management session, intervention. At the CX Imaging Day, delegates will hear about Tled by Iris Baumgartner, Bern, the latest data and innovations in the field of vascular imaging, Switzerland, will provide attendees with a programme covering a wide range of peripheral arterial, with an overview of congenital vas- venous and aortic topics. cular malformations, which will be of benefit to general vascular specialists. he peripheral arterial imaging The session will cover a range of topics, session will include technologies including diagnostic imaging principles, Tfrom Siemens, GE and Hansen, venous malformations, Klippel-Trenaunay looking at CO2 imaging, the value of Syndrome, arteriovenous malformations fusion imaging in treating complex and vascular malformations in children. Iris Baumgartner aortoiliac occlusions and how robotics Each of the session’s talks will be and 3D imaging can improve proce- followed by case presentations in an discuss the current challenges facing the dural success in complex pathologies. interactive discussion format, giving treatment of vascular malformations. Robotics will be the focus of the delegates the opportunity to directly venous imaging session as speakers interact with the expert speakers (Joe Tuesday 26 April (morning) explore the use of robotic technology Brookes, Andreas Saleh, Matthias – Olympia Room Learning in the failed treatment of central venous Widmer and Walter Wohlgemuth) and Centre stenosis and the removal of IVC filters. Koen Deloose The potential of robotic technol- ogy will also be discussed in the aortic imaging session, along with other topics CX Paediatric Vascular Issues including integrated planning for EVAR, Complementing the CX Vascular the use of cone beam CT with fusion Malformations session, the CX Paediatric technologies to minimise radiation use Vascular Issues session will focus on and the prevention of contrast induced conditions including congenital vascular nephrotoxicity in vascular procedures. abnormalities. George Hamilton, London, These three sessions will be chaired by UK, and Malcolm Simms, Birmingham, Tara Mastracci (London, UK) and Frank UK, are the course directors. Veith (New York, USA), and each section This year, the session will address will conclude with a panel discussion, issues related to imaging, and acute involving the chairs and the speakers. ischaemia pre-term, in neonates and in Following this, Stéphan Haulon children. This will be followed by presen- (Lille, France) and Richard McWil- Stéphan Haulon tations on chronic ischaemia and arterial George Hamilton liams (Liverpool, UK) will chair an pathologies. The discussion of venous abstract session of imaging presentations. their everyday practice, and showing how pathologies and malformations will close A discussion will follow each of the this can improve clinical outcomes. The the session. presentations, giving attendees the chance first, led by Haulon, will look at integrated For this year’s course the directors have to interact with the expert speakers. planning and endograft sizing using new invited the submission of paediatric vascu- In the afternoon, the focus will switch to EVAR ASSIST. The second, led by Deloose, lar cases concerning acute or chronic limb the Exhibition Hall, where delegates can will focus on preoperative planning and ischaemia, trauma, mid-aortic syndrome, see imaging technology from Siemens and fusion guidance for lower limb occlusions cancer resection and vascular malforma- GE first hand and speak with expert users. using the new Vessel ASSIST system. tions. These cases will be used to encour- Koen Deloose (Dendermonde, Belgium), age audience discussion. Stéphan Haulon (Lille, France), and Robert Thursday 28 April – Olympia Rhee (New York ,USA) will then lead three Room Learning Centre Tuesday 26 April (afternoon) – imaging workshops, discussing their new (morning) and Exhibition Hall Olympia Room Learning Centre Malcolm Simms ASSIST “Plan, guide and assess” tools in (afternoon)
12 Charing Cross Symposium floorplan March 2016 CX 2016 floorplan ar a ar r
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