VEITH

Developments in carotid artery disease diagnosis and treatment have always been an important component of the VEITHsymposium programs and there will be sessions focusing on this critical area of patient management throughout the entire meeting.

This year, sessions will include a Tuesday focus on unresolved controversies in the management of carotid artery disease. The session will be moderated by Bruce A. Perler, MD, and L. Nelson Hopkins, MD, and include presentations on the value of using biomarkers of brain injury associated with carotid interventions, and how to assess and treat such adverse events as cerebral hyperfusion syndrome and intracranial artery dissection, as well as best medical treatments for carotid patients.

Of particular interest, there will be a debate Tuesday on the need for completion imaging with duplex or angiography with Hans-Henning Eckstein, MD, PhD, and R. Clement Darling III, MD.

Presentations will also address some of the latest treatment techniques for carotid artery disease. For example, on Wednesday morning, Norman H. Kumins, MD, of the Cleveland Medical Center, will present a study on the duration of blood flow reversal during transcarotid artery revascularization (TCAR), an “increasingly popular alternative to carotid endarterctomy and transfemoral artery carotid stenting,” which is designed to provide increased neuroprotection during the placement and angioplasty of the carotid stent. They analyzed the relationship between the length of TCAR flow reversal time (FRT) and major adverse events in 307 patients who underwent TCAR at four high-volume institutions. They separated patients into short (3-7minutes); medium(8-12 minutes); and long group (greater than 12 minutes) FRT. They designated a subset of the long group patients of those with greater than or equal to 20 or more minutes FRT, which they defined as the very long group. The stroke, myocardial infarction, and death rates at 30 days were assessed for all patients and were compared them between groups.

Dr. Kumins will detail how the overall stroke rate was 1.3%, with all strokes considered minor, and all patients showing full recovery. The four strokes occurred in patients with FRT of 6, 7, 11, and 12 minutes, showing no difference in the composite stroke/death or stroke/death/MI rates among the groups, the researchers indicated.

Dr. Kumins will discuss how flow reversal time does not affect stroke rates in patients undergoing TCAR, and suggest that operators should focus on the technical aspects of the procedure during flow reversal rather than being concerned about the amount of FRT.

Developments in carotid artery disease diagnosis and treatment have always been an important component of the VEITHsymposium programs and there will be sessions focusing on this critical area of patient management throughout the entire meeting.

This year, sessions will include a Tuesday focus on unresolved controversies in the management of carotid artery disease. The session will be moderated by Bruce A. Perler, MD, and L. Nelson Hopkins, MD, and include presentations on the value of using biomarkers of brain injury associated with carotid interventions, and how to assess and treat such adverse events as cerebral hyperfusion syndrome and intracranial artery dissection, as well as best medical treatments for carotid patients.

Of particular interest, there will be a debate Tuesday on the need for completion imaging with duplex or angiography with Hans-Henning Eckstein, MD, PhD, and R. Clement Darling III, MD.

Presentations will also address some of the latest treatment techniques for carotid artery disease. For example, on Wednesday morning, Norman H. Kumins, MD, of the Cleveland Medical Center, will present a study on the duration of blood flow reversal during transcarotid artery revascularization (TCAR), an “increasingly popular alternative to carotid endarterctomy and transfemoral artery carotid stenting,” which is designed to provide increased neuroprotection during the placement and angioplasty of the carotid stent. They analyzed the relationship between the length of TCAR flow reversal time (FRT) and major adverse events in 307 patients who underwent TCAR at four high-volume institutions. They separated patients into short (3-7minutes); medium(8-12 minutes); and long group (greater than 12 minutes) FRT. They designated a subset of the long group patients of those with greater than or equal to 20 or more minutes FRT, which they defined as the very long group. The stroke, myocardial infarction, and death rates at 30 days were assessed for all patients and were compared them between groups.

Dr. Kumins will detail how the overall stroke rate was 1.3%, with all strokes considered minor, and all patients showing full recovery. The four strokes occurred in patients with FRT of 6, 7, 11, and 12 minutes, showing no difference in the composite stroke/death or stroke/death/MI rates among the groups, the researchers indicated.

Dr. Kumins will discuss how flow reversal time does not affect stroke rates in patients undergoing TCAR, and suggest that operators should focus on the technical aspects of the procedure during flow reversal rather than being concerned about the amount of FRT.

Developments in carotid artery disease diagnosis and treatment have always been an important component of the VEITHsymposium programs and there will be sessions focusing on this critical area of patient management throughout the entire meeting.

This year, sessions will include a Tuesday focus on unresolved controversies in the management of carotid artery disease. The session will be moderated by Bruce A. Perler, MD, and L. Nelson Hopkins, MD, and include presentations on the value of using biomarkers of brain injury associated with carotid interventions, and how to assess and treat such adverse events as cerebral hyperfusion syndrome and intracranial artery dissection, as well as best medical treatments for carotid patients.

Of particular interest, there will be a debate Tuesday on the need for completion imaging with duplex or angiography with Hans-Henning Eckstein, MD, PhD, and R. Clement Darling III, MD.

Presentations will also address some of the latest treatment techniques for carotid artery disease. For example, on Wednesday morning, Norman H. Kumins, MD, of the Cleveland Medical Center, will present a study on the duration of blood flow reversal during transcarotid artery revascularization (TCAR), an “increasingly popular alternative to carotid endarterctomy and transfemoral artery carotid stenting,” which is designed to provide increased neuroprotection during the placement and angioplasty of the carotid stent. They analyzed the relationship between the length of TCAR flow reversal time (FRT) and major adverse events in 307 patients who underwent TCAR at four high-volume institutions. They separated patients into short (3-7minutes); medium(8-12 minutes); and long group (greater than 12 minutes) FRT. They designated a subset of the long group patients of those with greater than or equal to 20 or more minutes FRT, which they defined as the very long group. The stroke, myocardial infarction, and death rates at 30 days were assessed for all patients and were compared them between groups.

Dr. Kumins will detail how the overall stroke rate was 1.3%, with all strokes considered minor, and all patients showing full recovery. The four strokes occurred in patients with FRT of 6, 7, 11, and 12 minutes, showing no difference in the composite stroke/death or stroke/death/MI rates among the groups, the researchers indicated.

Dr. Kumins will discuss how flow reversal time does not affect stroke rates in patients undergoing TCAR, and suggest that operators should focus on the technical aspects of the procedure during flow reversal rather than being concerned about the amount of FRT.

This year at the VEITHsymposium, lower extremity arterial disease diagnosis and treatment takes pride of place in multiple sessions on each day.

For example, Tuesday will feature a special afternoon program on Hot New Topics In Lower Extremity Occlusive Disease Treatment, and on Wednesday morning, an associate faculty session will be held on Progress In Lower Extremity Occlusive Disease And Its Treatments.

In one particular presentation on Wednesday morning, Arsalan Wafi, MBBS, a clinical researcher at St. George’s Vascular Institute, London, will present a 10-year prospective study demonstrating that the poor mobility, lack of statin use, and socioeconomic deprivation are all associated with worse survival after a major lower limb amputation. Dr. Wafi will discuss how he and his colleagues assessed consecutive 805 major lower limb amputation patients seen in the Roehampton Rehabilitation Center between January 2007 and January 2018, using prospective records, which included demographics, etiologies of limb loss, operative details, medications, and mortality data over a 10-year follow-up period.

A total of 611 (76%) occurred in men, and 194 (24%) in women. Etiologies included diabetes mellitus, peripheral vascular disease, and other causes such as trauma, malignancy, sepsis, and complex regional pain syndrome.

Dr. Wafi will present data showing that living in a deprived area and being further away from the rehabilitation center were both significantly associated with poorer survival. Diabetes mellitus or peripheral vascular disease were associated with significantly shorter survival, compared with other etiologies, and not being on a statin was associated with significantly worse survival among the vascular patients. In addition, poorer overall mobility at discharge from rehabilitation was associated with poorer survival, according to the researchers. However there was no significant difference in survival between below-knee and above-knee amputees, or between unilateral and bilateral amputees.

Thursday will be highlighted by a session on New Devices For Treating Lower Extremity Lesions By Endovascular Or Open Techniques, and Friday will see a session New Developments In The Treatment Of Popliteal Diseases And Aneurysms.

This is only one of many such studies focused on lower extremity arterial disease at this year’s VEITHsymposium.

This year at the VEITHsymposium, lower extremity arterial disease diagnosis and treatment takes pride of place in multiple sessions on each day.

For example, Tuesday will feature a special afternoon program on Hot New Topics In Lower Extremity Occlusive Disease Treatment, and on Wednesday morning, an associate faculty session will be held on Progress In Lower Extremity Occlusive Disease And Its Treatments.

In one particular presentation on Wednesday morning, Arsalan Wafi, MBBS, a clinical researcher at St. George’s Vascular Institute, London, will present a 10-year prospective study demonstrating that the poor mobility, lack of statin use, and socioeconomic deprivation are all associated with worse survival after a major lower limb amputation. Dr. Wafi will discuss how he and his colleagues assessed consecutive 805 major lower limb amputation patients seen in the Roehampton Rehabilitation Center between January 2007 and January 2018, using prospective records, which included demographics, etiologies of limb loss, operative details, medications, and mortality data over a 10-year follow-up period.

A total of 611 (76%) occurred in men, and 194 (24%) in women. Etiologies included diabetes mellitus, peripheral vascular disease, and other causes such as trauma, malignancy, sepsis, and complex regional pain syndrome.

Dr. Wafi will present data showing that living in a deprived area and being further away from the rehabilitation center were both significantly associated with poorer survival. Diabetes mellitus or peripheral vascular disease were associated with significantly shorter survival, compared with other etiologies, and not being on a statin was associated with significantly worse survival among the vascular patients. In addition, poorer overall mobility at discharge from rehabilitation was associated with poorer survival, according to the researchers. However there was no significant difference in survival between below-knee and above-knee amputees, or between unilateral and bilateral amputees.

Thursday will be highlighted by a session on New Devices For Treating Lower Extremity Lesions By Endovascular Or Open Techniques, and Friday will see a session New Developments In The Treatment Of Popliteal Diseases And Aneurysms.

This is only one of many such studies focused on lower extremity arterial disease at this year’s VEITHsymposium.

This year at the VEITHsymposium, lower extremity arterial disease diagnosis and treatment takes pride of place in multiple sessions on each day.

For example, Tuesday will feature a special afternoon program on Hot New Topics In Lower Extremity Occlusive Disease Treatment, and on Wednesday morning, an associate faculty session will be held on Progress In Lower Extremity Occlusive Disease And Its Treatments.

In one particular presentation on Wednesday morning, Arsalan Wafi, MBBS, a clinical researcher at St. George’s Vascular Institute, London, will present a 10-year prospective study demonstrating that the poor mobility, lack of statin use, and socioeconomic deprivation are all associated with worse survival after a major lower limb amputation. Dr. Wafi will discuss how he and his colleagues assessed consecutive 805 major lower limb amputation patients seen in the Roehampton Rehabilitation Center between January 2007 and January 2018, using prospective records, which included demographics, etiologies of limb loss, operative details, medications, and mortality data over a 10-year follow-up period.

A total of 611 (76%) occurred in men, and 194 (24%) in women. Etiologies included diabetes mellitus, peripheral vascular disease, and other causes such as trauma, malignancy, sepsis, and complex regional pain syndrome.

Dr. Wafi will present data showing that living in a deprived area and being further away from the rehabilitation center were both significantly associated with poorer survival. Diabetes mellitus or peripheral vascular disease were associated with significantly shorter survival, compared with other etiologies, and not being on a statin was associated with significantly worse survival among the vascular patients. In addition, poorer overall mobility at discharge from rehabilitation was associated with poorer survival, according to the researchers. However there was no significant difference in survival between below-knee and above-knee amputees, or between unilateral and bilateral amputees.

Thursday will be highlighted by a session on New Devices For Treating Lower Extremity Lesions By Endovascular Or Open Techniques, and Friday will see a session New Developments In The Treatment Of Popliteal Diseases And Aneurysms.

This is only one of many such studies focused on lower extremity arterial disease at this year’s VEITHsymposium.

NEW YORK – Artificial intelligence is currently linked to specific problem solving and is not some form of Terminator model capable of handling multiple tasks with autonomy. In other words, each time you hear the term “AI,” it is a computer solving a specific problem or task using algorithms “and not ‘thinking’ like you and me,” said Ido Weinberg, MD, assistant professor, Harvard Medical School, Boston.

AI is present in daily life – everything from cellphones to the Alexa voice interface on a smart speaker. That AI system, however, is amassing data, learning about you, and using that data intelligently, Dr. Weinberg said at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.

AI in health care make sense, he said, because the health sector is a vast consumer market with potential for financial gain. Repetition, which is common in the health sector, is one of the foundations required for using AI and robotics. If a task can be repeated, then it means a machine can do it, said Dr. Weinberg.

The spread of AI and robotics one day may improve health care accessibility in remote areas where physicians with the appropriate training may not be available.

AI is already at work in the health care industry. “Pulmonary nodule detection can be done better with machines than by people, pathological identification and scanning of various slides can be done better by a machine than by a humans,” he said.

Artificial intelligence also can be designed to detect emotion by assessing various cues in phrasing, key words, and tone. These AI functions already are being used by sales reps on the phone to defuse and control interactions with customers and complainants. AI also can be implemented in interactions with people, which is an important part of dealing with patients, Dr. Weinberg said. Drug discovery is a key area where AI is flourishing, as well.

Luckily, in terms of physicians keeping their jobs, there are barriers to the use of AI to replace clinicians, Dr. Weinberg pointed out. Health care is not a monolith, and every specialty is different, meaning AI would have to be tailored to each task and specialty for each unique field. Quick proliferation of AI across the board is unlikely, especially when the varying roles of nurses and physician assistants are included.

Although robots in science fiction stories and films often are capable of multitasking a variety of needs, robots at present are much more limited in real life. In surgical situations, for example, they can perform specifically tailored tasks but cannot extend beyond those defined parameters as a real surgeon can, according to Dr. Weinberg, and this lack of flexibility is a severe limitation on the expansion of AI into health care.

Despite these limitations, Dr. Weinberg urged attendees to consider how AI can be used to facilitate their work.

“Believe in the roadblocks, but be a fast adopter – an early adopter – and understand where AI can currently augment you and make you better and more productive,” he said. “And keep doing procedures; AI and robotics currently have a problem with most of those,” Dr. Weinberg concluded.

Dr. Weinberg reported no conflicts relevant to his talk.

mlesney@mdedge.com

NEW YORK – Artificial intelligence is currently linked to specific problem solving and is not some form of Terminator model capable of handling multiple tasks with autonomy. In other words, each time you hear the term “AI,” it is a computer solving a specific problem or task using algorithms “and not ‘thinking’ like you and me,” said Ido Weinberg, MD, assistant professor, Harvard Medical School, Boston.

AI is present in daily life – everything from cellphones to the Alexa voice interface on a smart speaker. That AI system, however, is amassing data, learning about you, and using that data intelligently, Dr. Weinberg said at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.

AI in health care make sense, he said, because the health sector is a vast consumer market with potential for financial gain. Repetition, which is common in the health sector, is one of the foundations required for using AI and robotics. If a task can be repeated, then it means a machine can do it, said Dr. Weinberg.

The spread of AI and robotics one day may improve health care accessibility in remote areas where physicians with the appropriate training may not be available.

AI is already at work in the health care industry. “Pulmonary nodule detection can be done better with machines than by people, pathological identification and scanning of various slides can be done better by a machine than by a humans,” he said.

Artificial intelligence also can be designed to detect emotion by assessing various cues in phrasing, key words, and tone. These AI functions already are being used by sales reps on the phone to defuse and control interactions with customers and complainants. AI also can be implemented in interactions with people, which is an important part of dealing with patients, Dr. Weinberg said. Drug discovery is a key area where AI is flourishing, as well.

Luckily, in terms of physicians keeping their jobs, there are barriers to the use of AI to replace clinicians, Dr. Weinberg pointed out. Health care is not a monolith, and every specialty is different, meaning AI would have to be tailored to each task and specialty for each unique field. Quick proliferation of AI across the board is unlikely, especially when the varying roles of nurses and physician assistants are included.

Although robots in science fiction stories and films often are capable of multitasking a variety of needs, robots at present are much more limited in real life. In surgical situations, for example, they can perform specifically tailored tasks but cannot extend beyond those defined parameters as a real surgeon can, according to Dr. Weinberg, and this lack of flexibility is a severe limitation on the expansion of AI into health care.

Despite these limitations, Dr. Weinberg urged attendees to consider how AI can be used to facilitate their work.

“Believe in the roadblocks, but be a fast adopter – an early adopter – and understand where AI can currently augment you and make you better and more productive,” he said. “And keep doing procedures; AI and robotics currently have a problem with most of those,” Dr. Weinberg concluded.

Dr. Weinberg reported no conflicts relevant to his talk.

mlesney@mdedge.com

NEW YORK – Artificial intelligence is currently linked to specific problem solving and is not some form of Terminator model capable of handling multiple tasks with autonomy. In other words, each time you hear the term “AI,” it is a computer solving a specific problem or task using algorithms “and not ‘thinking’ like you and me,” said Ido Weinberg, MD, assistant professor, Harvard Medical School, Boston.

AI is present in daily life – everything from cellphones to the Alexa voice interface on a smart speaker. That AI system, however, is amassing data, learning about you, and using that data intelligently, Dr. Weinberg said at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation.

AI in health care make sense, he said, because the health sector is a vast consumer market with potential for financial gain. Repetition, which is common in the health sector, is one of the foundations required for using AI and robotics. If a task can be repeated, then it means a machine can do it, said Dr. Weinberg.

The spread of AI and robotics one day may improve health care accessibility in remote areas where physicians with the appropriate training may not be available.

AI is already at work in the health care industry. “Pulmonary nodule detection can be done better with machines than by people, pathological identification and scanning of various slides can be done better by a machine than by a humans,” he said.

Artificial intelligence also can be designed to detect emotion by assessing various cues in phrasing, key words, and tone. These AI functions already are being used by sales reps on the phone to defuse and control interactions with customers and complainants. AI also can be implemented in interactions with people, which is an important part of dealing with patients, Dr. Weinberg said. Drug discovery is a key area where AI is flourishing, as well.

Luckily, in terms of physicians keeping their jobs, there are barriers to the use of AI to replace clinicians, Dr. Weinberg pointed out. Health care is not a monolith, and every specialty is different, meaning AI would have to be tailored to each task and specialty for each unique field. Quick proliferation of AI across the board is unlikely, especially when the varying roles of nurses and physician assistants are included.

Although robots in science fiction stories and films often are capable of multitasking a variety of needs, robots at present are much more limited in real life. In surgical situations, for example, they can perform specifically tailored tasks but cannot extend beyond those defined parameters as a real surgeon can, according to Dr. Weinberg, and this lack of flexibility is a severe limitation on the expansion of AI into health care.

Despite these limitations, Dr. Weinberg urged attendees to consider how AI can be used to facilitate their work.

“Believe in the roadblocks, but be a fast adopter – an early adopter – and understand where AI can currently augment you and make you better and more productive,” he said. “And keep doing procedures; AI and robotics currently have a problem with most of those,” Dr. Weinberg concluded.

Dr. Weinberg reported no conflicts relevant to his talk.

mlesney@mdedge.com

NEW YORK – The Vascular Quality Initiative (VQI) is designed to improve the quality, safety, and effectiveness of vascular health care, but also reduce costs through the collection and exchange of information, according to Larry W. Kraiss, MD, professor of surgery, University of Utah, Salt Lake City.

The VQI consists of three major components: a federally accredited patient safety organization (PSO), a registry, and a distributed network of quality groups, which can also serve as a platform for internal quality improvement efforts.

Even though registries are considered less reliable than the venerated randomized clinical trial models are, registries have some unique advantages, according to Dr. Kraiss, who spoke at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation. Randomized clinical trials (RCTs) are very expensive to conduct and are criticized for potentially not being generalizable because of their rigidly defined inclusion/exclusion criteria. Despite inherent problems with registry data, especially bias, there are now statistical methods to help account for the biases. Registry-controlled trials are going to be important to answer many questions that cannot be answered by RCTs. Such trials can be too costly or actually unethical to randomize under certain circumstances. Registries, however, provide real-world patient populations in greater numbers than RCTs can manage, including access to rare events that would otherwise not be detected.

The VQI holds an important place in this second tier and is an important source of information for clinical care.

The VQI has grown steadily since its inception, and there are more than 500 centers now participating, including 6 international centers, and 18 regional groups, according to Dr. Kraiss. There are more than 530,000 procedures contained within the VQI’s 12 registries, with more than half of them involving peripheral vascular interventions and carotid endarterectomies. “But there [are] a healthy number of cases in all of the other registries, which provide a very rich resource and evidence base,” he added.

The VQI is becoming very important in the regulatory framework, with the Food and Drug Administration embracing “real-world evidence” as a way to justify some of its decisions, and the VQI has been involved in this process. The VQI has coordinated several post-market surveillance programs, the two most important being in the areas of thoracic endovascular aortic repair (TEVAR) and transcarotid artery revascularization (TCAR), said Dr. Kraiss.

One of the important values of the VQI is the ability to examine benchmarks and to compare performance across centers. For example, looking at aortic abdominal aneurysm (AAA) repair data, the results showed that a number of centers were not following established Society for Vascular Society guidelines and that there were a substantial number of AAAs reported in the VQI that were treated when they were below the threshold for intervention and should have received routine observation only.

So, ultimately two of the greatest values of the VQI are the ability to use it as a means of local quality improvement, and to provide an avenue for important clinical research, Dr. Kraiss concluded.

Dr. Kraiss reported that they had no disclosures.

mlesney@mdedge.com

NEW YORK – The Vascular Quality Initiative (VQI) is designed to improve the quality, safety, and effectiveness of vascular health care, but also reduce costs through the collection and exchange of information, according to Larry W. Kraiss, MD, professor of surgery, University of Utah, Salt Lake City.

The VQI consists of three major components: a federally accredited patient safety organization (PSO), a registry, and a distributed network of quality groups, which can also serve as a platform for internal quality improvement efforts.

Even though registries are considered less reliable than the venerated randomized clinical trial models are, registries have some unique advantages, according to Dr. Kraiss, who spoke at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation. Randomized clinical trials (RCTs) are very expensive to conduct and are criticized for potentially not being generalizable because of their rigidly defined inclusion/exclusion criteria. Despite inherent problems with registry data, especially bias, there are now statistical methods to help account for the biases. Registry-controlled trials are going to be important to answer many questions that cannot be answered by RCTs. Such trials can be too costly or actually unethical to randomize under certain circumstances. Registries, however, provide real-world patient populations in greater numbers than RCTs can manage, including access to rare events that would otherwise not be detected.

The VQI holds an important place in this second tier and is an important source of information for clinical care.

The VQI has grown steadily since its inception, and there are more than 500 centers now participating, including 6 international centers, and 18 regional groups, according to Dr. Kraiss. There are more than 530,000 procedures contained within the VQI’s 12 registries, with more than half of them involving peripheral vascular interventions and carotid endarterectomies. “But there [are] a healthy number of cases in all of the other registries, which provide a very rich resource and evidence base,” he added.

The VQI is becoming very important in the regulatory framework, with the Food and Drug Administration embracing “real-world evidence” as a way to justify some of its decisions, and the VQI has been involved in this process. The VQI has coordinated several post-market surveillance programs, the two most important being in the areas of thoracic endovascular aortic repair (TEVAR) and transcarotid artery revascularization (TCAR), said Dr. Kraiss.

One of the important values of the VQI is the ability to examine benchmarks and to compare performance across centers. For example, looking at aortic abdominal aneurysm (AAA) repair data, the results showed that a number of centers were not following established Society for Vascular Society guidelines and that there were a substantial number of AAAs reported in the VQI that were treated when they were below the threshold for intervention and should have received routine observation only.

So, ultimately two of the greatest values of the VQI are the ability to use it as a means of local quality improvement, and to provide an avenue for important clinical research, Dr. Kraiss concluded.

Dr. Kraiss reported that they had no disclosures.

mlesney@mdedge.com

NEW YORK – The Vascular Quality Initiative (VQI) is designed to improve the quality, safety, and effectiveness of vascular health care, but also reduce costs through the collection and exchange of information, according to Larry W. Kraiss, MD, professor of surgery, University of Utah, Salt Lake City.

The VQI consists of three major components: a federally accredited patient safety organization (PSO), a registry, and a distributed network of quality groups, which can also serve as a platform for internal quality improvement efforts.

Even though registries are considered less reliable than the venerated randomized clinical trial models are, registries have some unique advantages, according to Dr. Kraiss, who spoke at a symposium on vascular and endovascular issues sponsored by the Cleveland Clinic Foundation. Randomized clinical trials (RCTs) are very expensive to conduct and are criticized for potentially not being generalizable because of their rigidly defined inclusion/exclusion criteria. Despite inherent problems with registry data, especially bias, there are now statistical methods to help account for the biases. Registry-controlled trials are going to be important to answer many questions that cannot be answered by RCTs. Such trials can be too costly or actually unethical to randomize under certain circumstances. Registries, however, provide real-world patient populations in greater numbers than RCTs can manage, including access to rare events that would otherwise not be detected.

The VQI holds an important place in this second tier and is an important source of information for clinical care.

The VQI has grown steadily since its inception, and there are more than 500 centers now participating, including 6 international centers, and 18 regional groups, according to Dr. Kraiss. There are more than 530,000 procedures contained within the VQI’s 12 registries, with more than half of them involving peripheral vascular interventions and carotid endarterectomies. “But there [are] a healthy number of cases in all of the other registries, which provide a very rich resource and evidence base,” he added.

The VQI is becoming very important in the regulatory framework, with the Food and Drug Administration embracing “real-world evidence” as a way to justify some of its decisions, and the VQI has been involved in this process. The VQI has coordinated several post-market surveillance programs, the two most important being in the areas of thoracic endovascular aortic repair (TEVAR) and transcarotid artery revascularization (TCAR), said Dr. Kraiss.

One of the important values of the VQI is the ability to examine benchmarks and to compare performance across centers. For example, looking at aortic abdominal aneurysm (AAA) repair data, the results showed that a number of centers were not following established Society for Vascular Society guidelines and that there were a substantial number of AAAs reported in the VQI that were treated when they were below the threshold for intervention and should have received routine observation only.

So, ultimately two of the greatest values of the VQI are the ability to use it as a means of local quality improvement, and to provide an avenue for important clinical research, Dr. Kraiss concluded.

Dr. Kraiss reported that they had no disclosures.

mlesney@mdedge.com

For 44 years, the latest pharmacologic, radiologic, surgical, and endovascular techniques and technologies have been presented at the VEITHsymposium, along with discussions of when these treatments are indicated. Updates on clinical trials and opportunities for dialogue with experts in the field provide insight along with the latest results of the various treatment modalities.

This information is packed into a single meeting with as many short presentations as possible - some  of them concurrent. Access has been facilitated by providing electronically archived material, including talks, slides, and panels after the meeting.  

To avoid the conundrum of having to choose between concurrent sessions, meeting attendees can access them through this year’s online library, which can be found at www.veithondemand.com. For individuals unable to attend the meeting, the online library is CME accredited so that they may receive credit for their educational viewing experience. 

VEITHsymposium has partnered with Edge Creek Media, Inc. to digitally capture the presentations from this year’s event and make them available online for cross-platform and mobile device viewing. Each webcast presentation will be produced with synchronous presenter audio, and slide content to reproduce  the presentations.  

The online library will contain over 1,200 webcast presentations and will include presentations from approximately 600 expert speakers. This library will recreate the remarkable educational experience of attending in person. It will also provide an invaluable resource of ongoing vascular information.  

Edge Creek Media is a specialized multimedia production company that offers custom live event recording and webcast streaming solutions. Other core services include mobile app development, live event production, audio/video post production, and multimedia web development. 

For more information, visit www.edgecreekmedia.com or contact the company at info@edgecreekmedia.com. ■

For 44 years, the latest pharmacologic, radiologic, surgical, and endovascular techniques and technologies have been presented at the VEITHsymposium, along with discussions of when these treatments are indicated. Updates on clinical trials and opportunities for dialogue with experts in the field provide insight along with the latest results of the various treatment modalities.

This information is packed into a single meeting with as many short presentations as possible - some  of them concurrent. Access has been facilitated by providing electronically archived material, including talks, slides, and panels after the meeting.  

To avoid the conundrum of having to choose between concurrent sessions, meeting attendees can access them through this year’s online library, which can be found at www.veithondemand.com. For individuals unable to attend the meeting, the online library is CME accredited so that they may receive credit for their educational viewing experience. 

VEITHsymposium has partnered with Edge Creek Media, Inc. to digitally capture the presentations from this year’s event and make them available online for cross-platform and mobile device viewing. Each webcast presentation will be produced with synchronous presenter audio, and slide content to reproduce  the presentations.  

The online library will contain over 1,200 webcast presentations and will include presentations from approximately 600 expert speakers. This library will recreate the remarkable educational experience of attending in person. It will also provide an invaluable resource of ongoing vascular information.  

Edge Creek Media is a specialized multimedia production company that offers custom live event recording and webcast streaming solutions. Other core services include mobile app development, live event production, audio/video post production, and multimedia web development. 

For more information, visit www.edgecreekmedia.com or contact the company at info@edgecreekmedia.com. ■

For 44 years, the latest pharmacologic, radiologic, surgical, and endovascular techniques and technologies have been presented at the VEITHsymposium, along with discussions of when these treatments are indicated. Updates on clinical trials and opportunities for dialogue with experts in the field provide insight along with the latest results of the various treatment modalities.

This information is packed into a single meeting with as many short presentations as possible - some  of them concurrent. Access has been facilitated by providing electronically archived material, including talks, slides, and panels after the meeting.  

To avoid the conundrum of having to choose between concurrent sessions, meeting attendees can access them through this year’s online library, which can be found at www.veithondemand.com. For individuals unable to attend the meeting, the online library is CME accredited so that they may receive credit for their educational viewing experience. 

VEITHsymposium has partnered with Edge Creek Media, Inc. to digitally capture the presentations from this year’s event and make them available online for cross-platform and mobile device viewing. Each webcast presentation will be produced with synchronous presenter audio, and slide content to reproduce  the presentations.  

The online library will contain over 1,200 webcast presentations and will include presentations from approximately 600 expert speakers. This library will recreate the remarkable educational experience of attending in person. It will also provide an invaluable resource of ongoing vascular information.  

Edge Creek Media is a specialized multimedia production company that offers custom live event recording and webcast streaming solutions. Other core services include mobile app development, live event production, audio/video post production, and multimedia web development. 

For more information, visit www.edgecreekmedia.com or contact the company at info@edgecreekmedia.com. ■

Optimizing care of dialysis patients will be the focus of a comprehensive program with five sessions, “New Developments in Vascular Access for Hemodialysis,” taking place all day Saturday. 

“Chronic kidney disease (CKD) has become an epidemic in the United States. Medicare spending for patients with CKD ages 65 and older exceeded $50 billion in 2013 and represented 20% of all Medicare spending for this age group. This epidemic has been driven by the rise in diabetes, hypertension and obesity and has resulted in a staggering increase in the number of patients requiring hemodialysis,” stated program organizer Dr. Larry A. Scher, professor of clinical surgery at Albert Einstein College of Medicine and attending surgeon at Montefiore Medical Center. 

“Providing functioning vascular access for these patients has become a significant challenge for vascular surgeons, transplant surgeons, interventional nephrologists, and interventional radiologists along with nephrologists, nurses, dialysis technicians, and others interested in optimizing the care of dialysis patients,” he continued. “These practitioners are the target audience for this program, which will address many important topics in hemodialysis access.” 

There will be five sessions covering issues in the field, optimization of outcomes, political, economic and legal topics, new technologies and concepts, and updates on clinical challenges. 

The first sessions will cover important issues in the field and outcome optimization. Experts will address topics such as fistula maturation, use of ultrasound for access planning and cannulation, importance of dialysis maturation, significance of dialysis blood flow, and the use of stent grafts and drug-eluting balloons. Other talks will address cognitive function in patients with chronic kidney disease, measuring cardiac output in the dialysis improve patient safety, review of significant contributions to the literature, and an update on the mission of Kidney Health International. 

“We are honored to have Harald C. Ott, MD, principal investigator at the Ott Laboratory for Organ Engineering and Regeneration at Massachusetts General Hospital as our guest speaker,” said Dr. Scher. “There is a critical shortage of kidneys available for transplantation, and Dr. Ott has performed important research on reengineered organs.” His presentation will be on the revolution in renal replacement therapy, specifically the current status of the bio-artificial kidney. 

“The talk should be of great interest to medical professionals interested in improving care for our patients with end-stage renal disease,” said Dr. Scher. Other session talks will discuss Medicare costs for patients on hemodialysis, changes in reimbursement for outpatient procedures, and training of vascular access surgeons. 

“The segment on new technologies and concepts will present updated results of several important clinical trials, including efforts aimed at improving fistula maturation with elastase, sirolimus, and the VasQ device,” explained Dr. Scher. Results will be presented of trials of minimally invasive technologies for creating hemodialysis access. Also covered will be a unique sensor capable of providing remote monitoring of AV fistulas and grafts, as well as the RADAR technique, which emphasizes the importance of hemodynamics in arteriovenous fistula maturation. 

“The final session will delve into clinical issues in hemodialysis access,” said Dr. Scher. “There will be several talks about achieving successful access in challenging patient populations including obese, elderly and hypercoagulable patients, as well as patients with implantable cardiac devices.” Subject areas will include the role of biologic grafts in hemodialysis access and management of dialysis access complications, including steal syndrome, high flow fistula, central venous stenosis, aneurysms, and infection. 

“We have assembled an expert faculty that will offer a comprehensive overview of a wide-range of topics of interest to physicians and allied professionals who care for patients with end-stage renal disease,” said Dr. Scher. “Panel discussions will further enhance the program, allowing attendees to not only interact with faculty, but also discuss topics of interest and concern to their clinical practices.” ■

Optimizing care of dialysis patients will be the focus of a comprehensive program with five sessions, “New Developments in Vascular Access for Hemodialysis,” taking place all day Saturday. 

“Chronic kidney disease (CKD) has become an epidemic in the United States. Medicare spending for patients with CKD ages 65 and older exceeded $50 billion in 2013 and represented 20% of all Medicare spending for this age group. This epidemic has been driven by the rise in diabetes, hypertension and obesity and has resulted in a staggering increase in the number of patients requiring hemodialysis,” stated program organizer Dr. Larry A. Scher, professor of clinical surgery at Albert Einstein College of Medicine and attending surgeon at Montefiore Medical Center. 

“Providing functioning vascular access for these patients has become a significant challenge for vascular surgeons, transplant surgeons, interventional nephrologists, and interventional radiologists along with nephrologists, nurses, dialysis technicians, and others interested in optimizing the care of dialysis patients,” he continued. “These practitioners are the target audience for this program, which will address many important topics in hemodialysis access.” 

There will be five sessions covering issues in the field, optimization of outcomes, political, economic and legal topics, new technologies and concepts, and updates on clinical challenges. 

The first sessions will cover important issues in the field and outcome optimization. Experts will address topics such as fistula maturation, use of ultrasound for access planning and cannulation, importance of dialysis maturation, significance of dialysis blood flow, and the use of stent grafts and drug-eluting balloons. Other talks will address cognitive function in patients with chronic kidney disease, measuring cardiac output in the dialysis improve patient safety, review of significant contributions to the literature, and an update on the mission of Kidney Health International. 

“We are honored to have Harald C. Ott, MD, principal investigator at the Ott Laboratory for Organ Engineering and Regeneration at Massachusetts General Hospital as our guest speaker,” said Dr. Scher. “There is a critical shortage of kidneys available for transplantation, and Dr. Ott has performed important research on reengineered organs.” His presentation will be on the revolution in renal replacement therapy, specifically the current status of the bio-artificial kidney. 

“The talk should be of great interest to medical professionals interested in improving care for our patients with end-stage renal disease,” said Dr. Scher. Other session talks will discuss Medicare costs for patients on hemodialysis, changes in reimbursement for outpatient procedures, and training of vascular access surgeons. 

“The segment on new technologies and concepts will present updated results of several important clinical trials, including efforts aimed at improving fistula maturation with elastase, sirolimus, and the VasQ device,” explained Dr. Scher. Results will be presented of trials of minimally invasive technologies for creating hemodialysis access. Also covered will be a unique sensor capable of providing remote monitoring of AV fistulas and grafts, as well as the RADAR technique, which emphasizes the importance of hemodynamics in arteriovenous fistula maturation. 

“The final session will delve into clinical issues in hemodialysis access,” said Dr. Scher. “There will be several talks about achieving successful access in challenging patient populations including obese, elderly and hypercoagulable patients, as well as patients with implantable cardiac devices.” Subject areas will include the role of biologic grafts in hemodialysis access and management of dialysis access complications, including steal syndrome, high flow fistula, central venous stenosis, aneurysms, and infection. 

“We have assembled an expert faculty that will offer a comprehensive overview of a wide-range of topics of interest to physicians and allied professionals who care for patients with end-stage renal disease,” said Dr. Scher. “Panel discussions will further enhance the program, allowing attendees to not only interact with faculty, but also discuss topics of interest and concern to their clinical practices.” ■

Optimizing care of dialysis patients will be the focus of a comprehensive program with five sessions, “New Developments in Vascular Access for Hemodialysis,” taking place all day Saturday. 

“Chronic kidney disease (CKD) has become an epidemic in the United States. Medicare spending for patients with CKD ages 65 and older exceeded $50 billion in 2013 and represented 20% of all Medicare spending for this age group. This epidemic has been driven by the rise in diabetes, hypertension and obesity and has resulted in a staggering increase in the number of patients requiring hemodialysis,” stated program organizer Dr. Larry A. Scher, professor of clinical surgery at Albert Einstein College of Medicine and attending surgeon at Montefiore Medical Center. 

“Providing functioning vascular access for these patients has become a significant challenge for vascular surgeons, transplant surgeons, interventional nephrologists, and interventional radiologists along with nephrologists, nurses, dialysis technicians, and others interested in optimizing the care of dialysis patients,” he continued. “These practitioners are the target audience for this program, which will address many important topics in hemodialysis access.” 

There will be five sessions covering issues in the field, optimization of outcomes, political, economic and legal topics, new technologies and concepts, and updates on clinical challenges. 

The first sessions will cover important issues in the field and outcome optimization. Experts will address topics such as fistula maturation, use of ultrasound for access planning and cannulation, importance of dialysis maturation, significance of dialysis blood flow, and the use of stent grafts and drug-eluting balloons. Other talks will address cognitive function in patients with chronic kidney disease, measuring cardiac output in the dialysis improve patient safety, review of significant contributions to the literature, and an update on the mission of Kidney Health International. 

“We are honored to have Harald C. Ott, MD, principal investigator at the Ott Laboratory for Organ Engineering and Regeneration at Massachusetts General Hospital as our guest speaker,” said Dr. Scher. “There is a critical shortage of kidneys available for transplantation, and Dr. Ott has performed important research on reengineered organs.” His presentation will be on the revolution in renal replacement therapy, specifically the current status of the bio-artificial kidney. 

“The talk should be of great interest to medical professionals interested in improving care for our patients with end-stage renal disease,” said Dr. Scher. Other session talks will discuss Medicare costs for patients on hemodialysis, changes in reimbursement for outpatient procedures, and training of vascular access surgeons. 

“The segment on new technologies and concepts will present updated results of several important clinical trials, including efforts aimed at improving fistula maturation with elastase, sirolimus, and the VasQ device,” explained Dr. Scher. Results will be presented of trials of minimally invasive technologies for creating hemodialysis access. Also covered will be a unique sensor capable of providing remote monitoring of AV fistulas and grafts, as well as the RADAR technique, which emphasizes the importance of hemodynamics in arteriovenous fistula maturation. 

“The final session will delve into clinical issues in hemodialysis access,” said Dr. Scher. “There will be several talks about achieving successful access in challenging patient populations including obese, elderly and hypercoagulable patients, as well as patients with implantable cardiac devices.” Subject areas will include the role of biologic grafts in hemodialysis access and management of dialysis access complications, including steal syndrome, high flow fistula, central venous stenosis, aneurysms, and infection. 

“We have assembled an expert faculty that will offer a comprehensive overview of a wide-range of topics of interest to physicians and allied professionals who care for patients with end-stage renal disease,” said Dr. Scher. “Panel discussions will further enhance the program, allowing attendees to not only interact with faculty, but also discuss topics of interest and concern to their clinical practices.” ■

The options for treatment and management of superficial vein thrombosis will be the focus of “Venous Imaging, Thrombophilia” on Saturday morning. 

“This session will include talks on management of superficial vein thrombosis using direct oral anticoagulants, balancing anticoagulation with bleeding risk after surgery, and predicting patients at risk of post-thrombotic syndrome,” said Dr. Ian J. Franklin of the Imperial College and London Vascular Clinic. Dr. Franklin is co-moderator of the second half of the morning session. “There is much variation in practice in these areas, which will be addressed during the presentations,” he said.

“We have a fairly decent grasp regarding the optimal management of some aspects of venous disease,” added co-moderator Dr. Timothy K. Liem, professor of surgery at Oregon Health & Science University and codirector for quality at the Knight Cardiovascular Institute. “For example, in patients with proximal deep vein thrombosis or pulmonary embolism, the vast majority of clinicians would administer therapeutic anticoagulation for at least 3 months. However, when it comes to other very common venous problems and scenarios, such as superficial vein thrombosis (with or without the presence of venous reflux), there are still significant knowledge gaps with regard to optimal care. The same goes for perioperative management of anticoagulation and prevention of post-thrombotic syndrome,” he continued. “This has led to significant variability in the ways patients are treated. Attendees will learn more about these issues and ways to better manage their patients.” 

Dr. Franklin and Dr. Liem will each be making several presentations. 

“Trial evidence is consistent in showing that risk of venous thromboembolism (VTE) in patients with superficial vein thrombosis is reduced significantly by prolonged treatment with anticoagulants, but the number needed to prevent one VTE episode is more than 80,” explained Dr. Franklin. “This presents problems relating to cost and clinical effectiveness, which will be discussed in the session.” In one talk, Dr. Franklin will be discussing the grading of severity of venous thrombophlebitis and variation of treatment between primary and secondary care. He will also be covering treatment options: anticoagulation, compression, and follow-up. 

Dr. Liem will be highlighting anticoagulation issues, looking at the use of direct oral anticoagulants in one talk and management of anticoagulation to avoid postoperative hemorrhage in another. “The presentations will allow attendees who specialize in venous disease to understand when to anticoagulate and when to administer compression for patients with superficial vein thrombosis,” he stated. “It will also allow these physicians to better identify patients who are at increased risk of developing post-thrombotic syndrome.” In addition, he noted, “we hope to provide a better understanding regarding optimal strategies for managing coagulation that minimize the risk of postoperative hemorrhage while reducing the risk for recurrent thromboembolism during surgery or other invasive procedures.” 

Dr. Tomasz Urbanek of the Medical University of Silesia, Katowice, Poland, will present the final talk on the predictive factors of post-thrombotic syndrome. When asked how the session might influence the practices of those in attendance, Dr. Franklin replied, “Hopefully, it will result in more rational use of anticoagulation treatment for patients with superficial vein thrombosis, better use of direct oral anticoagulants as a treatment option, and safer surgery on anticoagulated patients.” 

Dr. Liem concluded, “These sessions will have the goal of helping clinicians standardize as much of our care as possible.” Dr. Franklin added, “The take-home message is better risk stratification may help rationalize treatment.” ■

The options for treatment and management of superficial vein thrombosis will be the focus of “Venous Imaging, Thrombophilia” on Saturday morning. 

“This session will include talks on management of superficial vein thrombosis using direct oral anticoagulants, balancing anticoagulation with bleeding risk after surgery, and predicting patients at risk of post-thrombotic syndrome,” said Dr. Ian J. Franklin of the Imperial College and London Vascular Clinic. Dr. Franklin is co-moderator of the second half of the morning session. “There is much variation in practice in these areas, which will be addressed during the presentations,” he said.

“We have a fairly decent grasp regarding the optimal management of some aspects of venous disease,” added co-moderator Dr. Timothy K. Liem, professor of surgery at Oregon Health & Science University and codirector for quality at the Knight Cardiovascular Institute. “For example, in patients with proximal deep vein thrombosis or pulmonary embolism, the vast majority of clinicians would administer therapeutic anticoagulation for at least 3 months. However, when it comes to other very common venous problems and scenarios, such as superficial vein thrombosis (with or without the presence of venous reflux), there are still significant knowledge gaps with regard to optimal care. The same goes for perioperative management of anticoagulation and prevention of post-thrombotic syndrome,” he continued. “This has led to significant variability in the ways patients are treated. Attendees will learn more about these issues and ways to better manage their patients.” 

Dr. Franklin and Dr. Liem will each be making several presentations. 

“Trial evidence is consistent in showing that risk of venous thromboembolism (VTE) in patients with superficial vein thrombosis is reduced significantly by prolonged treatment with anticoagulants, but the number needed to prevent one VTE episode is more than 80,” explained Dr. Franklin. “This presents problems relating to cost and clinical effectiveness, which will be discussed in the session.” In one talk, Dr. Franklin will be discussing the grading of severity of venous thrombophlebitis and variation of treatment between primary and secondary care. He will also be covering treatment options: anticoagulation, compression, and follow-up. 

Dr. Liem will be highlighting anticoagulation issues, looking at the use of direct oral anticoagulants in one talk and management of anticoagulation to avoid postoperative hemorrhage in another. “The presentations will allow attendees who specialize in venous disease to understand when to anticoagulate and when to administer compression for patients with superficial vein thrombosis,” he stated. “It will also allow these physicians to better identify patients who are at increased risk of developing post-thrombotic syndrome.” In addition, he noted, “we hope to provide a better understanding regarding optimal strategies for managing coagulation that minimize the risk of postoperative hemorrhage while reducing the risk for recurrent thromboembolism during surgery or other invasive procedures.” 

Dr. Tomasz Urbanek of the Medical University of Silesia, Katowice, Poland, will present the final talk on the predictive factors of post-thrombotic syndrome. When asked how the session might influence the practices of those in attendance, Dr. Franklin replied, “Hopefully, it will result in more rational use of anticoagulation treatment for patients with superficial vein thrombosis, better use of direct oral anticoagulants as a treatment option, and safer surgery on anticoagulated patients.” 

Dr. Liem concluded, “These sessions will have the goal of helping clinicians standardize as much of our care as possible.” Dr. Franklin added, “The take-home message is better risk stratification may help rationalize treatment.” ■

The options for treatment and management of superficial vein thrombosis will be the focus of “Venous Imaging, Thrombophilia” on Saturday morning. 

“This session will include talks on management of superficial vein thrombosis using direct oral anticoagulants, balancing anticoagulation with bleeding risk after surgery, and predicting patients at risk of post-thrombotic syndrome,” said Dr. Ian J. Franklin of the Imperial College and London Vascular Clinic. Dr. Franklin is co-moderator of the second half of the morning session. “There is much variation in practice in these areas, which will be addressed during the presentations,” he said.

“We have a fairly decent grasp regarding the optimal management of some aspects of venous disease,” added co-moderator Dr. Timothy K. Liem, professor of surgery at Oregon Health & Science University and codirector for quality at the Knight Cardiovascular Institute. “For example, in patients with proximal deep vein thrombosis or pulmonary embolism, the vast majority of clinicians would administer therapeutic anticoagulation for at least 3 months. However, when it comes to other very common venous problems and scenarios, such as superficial vein thrombosis (with or without the presence of venous reflux), there are still significant knowledge gaps with regard to optimal care. The same goes for perioperative management of anticoagulation and prevention of post-thrombotic syndrome,” he continued. “This has led to significant variability in the ways patients are treated. Attendees will learn more about these issues and ways to better manage their patients.” 

Dr. Franklin and Dr. Liem will each be making several presentations. 

“Trial evidence is consistent in showing that risk of venous thromboembolism (VTE) in patients with superficial vein thrombosis is reduced significantly by prolonged treatment with anticoagulants, but the number needed to prevent one VTE episode is more than 80,” explained Dr. Franklin. “This presents problems relating to cost and clinical effectiveness, which will be discussed in the session.” In one talk, Dr. Franklin will be discussing the grading of severity of venous thrombophlebitis and variation of treatment between primary and secondary care. He will also be covering treatment options: anticoagulation, compression, and follow-up. 

Dr. Liem will be highlighting anticoagulation issues, looking at the use of direct oral anticoagulants in one talk and management of anticoagulation to avoid postoperative hemorrhage in another. “The presentations will allow attendees who specialize in venous disease to understand when to anticoagulate and when to administer compression for patients with superficial vein thrombosis,” he stated. “It will also allow these physicians to better identify patients who are at increased risk of developing post-thrombotic syndrome.” In addition, he noted, “we hope to provide a better understanding regarding optimal strategies for managing coagulation that minimize the risk of postoperative hemorrhage while reducing the risk for recurrent thromboembolism during surgery or other invasive procedures.” 

Dr. Tomasz Urbanek of the Medical University of Silesia, Katowice, Poland, will present the final talk on the predictive factors of post-thrombotic syndrome. When asked how the session might influence the practices of those in attendance, Dr. Franklin replied, “Hopefully, it will result in more rational use of anticoagulation treatment for patients with superficial vein thrombosis, better use of direct oral anticoagulants as a treatment option, and safer surgery on anticoagulated patients.” 

Dr. Liem concluded, “These sessions will have the goal of helping clinicians standardize as much of our care as possible.” Dr. Franklin added, “The take-home message is better risk stratification may help rationalize treatment.” ■

The ongoing discussion over the optimal management of infection in aneurysms and grafts takes center stage in the session, “New Developments in the Treatment of Infected Aneurysms, Prosthetic Arterial Grafts, and Aortic Endografts,” on Friday morning. The session includes two debates: one on mycotic abdominal aortic aneurysms and what to do about them, and the other on the optimal techniques for handling infected aortic grafts and endografts.

“The management of infected aortic grafts is challenging and controversial,” according to Dr. Keith Calligaro, co-moderator of the session. Different aspects of treatment will be discussed, said Dr. Calligaro, chief of the section of vascular surgery and endovascular therapy at Pennsylvania Hospital, and clinical professor of surgery, University of Pennsylvania School of Medicine.

The ongoing discussion over the optimal management of infection in aneurysms and grafts takes center stage in the session, “New Developments in the Treatment of Infected Aneurysms, Prosthetic Arterial Grafts, and Aortic Endografts,” on Friday morning. The session includes two debates: one on mycotic abdominal aortic aneurysms and what to do about them, and the other on the optimal techniques for handling infected aortic grafts and endografts.

“The management of infected aortic grafts is challenging and controversial,” according to Dr. Keith Calligaro, co-moderator of the session. Different aspects of treatment will be discussed, said Dr. Calligaro, chief of the section of vascular surgery and endovascular therapy at Pennsylvania Hospital, and clinical professor of surgery, University of Pennsylvania School of Medicine.

The ongoing discussion over the optimal management of infection in aneurysms and grafts takes center stage in the session, “New Developments in the Treatment of Infected Aneurysms, Prosthetic Arterial Grafts, and Aortic Endografts,” on Friday morning. The session includes two debates: one on mycotic abdominal aortic aneurysms and what to do about them, and the other on the optimal techniques for handling infected aortic grafts and endografts.

“The management of infected aortic grafts is challenging and controversial,” according to Dr. Keith Calligaro, co-moderator of the session. Different aspects of treatment will be discussed, said Dr. Calligaro, chief of the section of vascular surgery and endovascular therapy at Pennsylvania Hospital, and clinical professor of surgery, University of Pennsylvania School of Medicine.

Today we are witnessing unprecedented rapid development and dissemination of new scientific information regarding vascular diseases, and it is becoming increasingly difficult for busy practitioners to keep up with the avalanche of information, according to Dr. Bruce A. Perler.

To help practitioners differentiate the hype from reality, the “Progress in the Medical Treatments of Vascular Disease; Vascular Diseases and Risk Prediction” session on Friday will bring together internationally respected experts in the field. These faculty will present “the latest and most important advances in the perioperative and long-term medical management of our patients in a succinct and easily digestible fashion,” said Dr. Perler of Johns Hopkins University School of Medicine, who will co-moderate the session with Dr. Caron B. Rockman of New York University School of Medicine.

Today we are witnessing unprecedented rapid development and dissemination of new scientific information regarding vascular diseases, and it is becoming increasingly difficult for busy practitioners to keep up with the avalanche of information, according to Dr. Bruce A. Perler.

To help practitioners differentiate the hype from reality, the “Progress in the Medical Treatments of Vascular Disease; Vascular Diseases and Risk Prediction” session on Friday will bring together internationally respected experts in the field. These faculty will present “the latest and most important advances in the perioperative and long-term medical management of our patients in a succinct and easily digestible fashion,” said Dr. Perler of Johns Hopkins University School of Medicine, who will co-moderate the session with Dr. Caron B. Rockman of New York University School of Medicine.

Today we are witnessing unprecedented rapid development and dissemination of new scientific information regarding vascular diseases, and it is becoming increasingly difficult for busy practitioners to keep up with the avalanche of information, according to Dr. Bruce A. Perler.

To help practitioners differentiate the hype from reality, the “Progress in the Medical Treatments of Vascular Disease; Vascular Diseases and Risk Prediction” session on Friday will bring together internationally respected experts in the field. These faculty will present “the latest and most important advances in the perioperative and long-term medical management of our patients in a succinct and easily digestible fashion,” said Dr. Perler of Johns Hopkins University School of Medicine, who will co-moderate the session with Dr. Caron B. Rockman of New York University School of Medicine.

“There is a ‘one size fits all’ strategy by a lot of people who simply read a paper or a guideline and say that’s how patients must be treated,” said co-moderator Dr. Ross Naylor, professor of vascular surgery at the University of Leicester and a consultant vascular surgeon at the Leicester Royal Infirmary. “This session will question how you actually treat your patients, so I think it will open people’s eyes toward the benefits of modern medical therapy. It also questions the role of carotid stenting in asymptomatic patients and how to reduce the risks; unless we reduce the risks, it’s going to be less likely to be adopted.”

The session has several themes, he explained. One is the benefit of optimizing best medical therapy: “There are a couple of papers on the role of starting statins before carotid surgery or carotid stenting. There’s now good evidence that if you do this, you will reduce the perioperative risk of stroke, and this needs to be emphasized more in guidelines.”

In addition, Dr. Naylor said, there is increasing evidence that patients who have asymptomatic carotid stenosis, and who are started on good quality medical therapy, have much lower annual risks of stroke than they would 15 to 20 years ago. Presentations by Dr. J. David Spence of Western University and University Hospital in London, Canada, and by Dr. Henrik Sillesen of the University of Copenhagen and Rigshospitalet, will question current attitudes toward intervening in asymptomatic patients. “Their big plea is that the majority can be treated medically,” Dr. Naylor said. “Only a small proportion actually will benefit from stenting and surgery.” Dr. Spence will address the value of Mediterranean and Nordic diets in patients with carotid stenosis, while Dr. Sillesen will examine if stenosis or plaque progression are reasons to treat asymptomatic patients with carotid artery stenting (CAS) versus carotid artery endarterectomy (CEA).

“There is a ‘one size fits all’ strategy by a lot of people who simply read a paper or a guideline and say that’s how patients must be treated,” said co-moderator Dr. Ross Naylor, professor of vascular surgery at the University of Leicester and a consultant vascular surgeon at the Leicester Royal Infirmary. “This session will question how you actually treat your patients, so I think it will open people’s eyes toward the benefits of modern medical therapy. It also questions the role of carotid stenting in asymptomatic patients and how to reduce the risks; unless we reduce the risks, it’s going to be less likely to be adopted.”

The session has several themes, he explained. One is the benefit of optimizing best medical therapy: “There are a couple of papers on the role of starting statins before carotid surgery or carotid stenting. There’s now good evidence that if you do this, you will reduce the perioperative risk of stroke, and this needs to be emphasized more in guidelines.”

In addition, Dr. Naylor said, there is increasing evidence that patients who have asymptomatic carotid stenosis, and who are started on good quality medical therapy, have much lower annual risks of stroke than they would 15 to 20 years ago. Presentations by Dr. J. David Spence of Western University and University Hospital in London, Canada, and by Dr. Henrik Sillesen of the University of Copenhagen and Rigshospitalet, will question current attitudes toward intervening in asymptomatic patients. “Their big plea is that the majority can be treated medically,” Dr. Naylor said. “Only a small proportion actually will benefit from stenting and surgery.” Dr. Spence will address the value of Mediterranean and Nordic diets in patients with carotid stenosis, while Dr. Sillesen will examine if stenosis or plaque progression are reasons to treat asymptomatic patients with carotid artery stenting (CAS) versus carotid artery endarterectomy (CEA).

“There is a ‘one size fits all’ strategy by a lot of people who simply read a paper or a guideline and say that’s how patients must be treated,” said co-moderator Dr. Ross Naylor, professor of vascular surgery at the University of Leicester and a consultant vascular surgeon at the Leicester Royal Infirmary. “This session will question how you actually treat your patients, so I think it will open people’s eyes toward the benefits of modern medical therapy. It also questions the role of carotid stenting in asymptomatic patients and how to reduce the risks; unless we reduce the risks, it’s going to be less likely to be adopted.”

The session has several themes, he explained. One is the benefit of optimizing best medical therapy: “There are a couple of papers on the role of starting statins before carotid surgery or carotid stenting. There’s now good evidence that if you do this, you will reduce the perioperative risk of stroke, and this needs to be emphasized more in guidelines.”

In addition, Dr. Naylor said, there is increasing evidence that patients who have asymptomatic carotid stenosis, and who are started on good quality medical therapy, have much lower annual risks of stroke than they would 15 to 20 years ago. Presentations by Dr. J. David Spence of Western University and University Hospital in London, Canada, and by Dr. Henrik Sillesen of the University of Copenhagen and Rigshospitalet, will question current attitudes toward intervening in asymptomatic patients. “Their big plea is that the majority can be treated medically,” Dr. Naylor said. “Only a small proportion actually will benefit from stenting and surgery.” Dr. Spence will address the value of Mediterranean and Nordic diets in patients with carotid stenosis, while Dr. Sillesen will examine if stenosis or plaque progression are reasons to treat asymptomatic patients with carotid artery stenting (CAS) versus carotid artery endarterectomy (CEA).