offered attendees the opportunity to see that there can be different views on approaching a case which can produce similar successful outcomes.

Transcription

1 Monday, February 10 TUESDAY S HIGHLIGHTS Set Your Alarm Challenging Case Presentations 6:30 a.m., Salon V A full house views Monday morning s live case broadcast from the City Clinic in Sofia, Bulgaria. icon 2014 Showcases International Flair icon 2014 opened on Monday, February 10, with a strong program that highlighted the meeting s cutting-edge position in the industry as well as its international influence. Eight countries were represented during the Challenging Case Presentations session. The early morning start didn t deter attendees, who arrived early eager to hear colleagues discuss their chosen approaches and complications that occurred. (See page 2 for recap.) Live cases were broadcast from City Clinic in Sofia, Bulgaria, Sao Paulo Vascular and Endovascular Surgery Institute in Sao Paulo, Brazil, and the Cardiovascular Institute of the South, Houma, LA. Interactive discussion between the session moderators and case operators offered attendees the opportunity to see that there can be different views on approaching a case which can produce similar successful outcomes. Interactive discussion between case operator Ivo Petrov, MD, PhD, and panelists Chris White, MD, and Claudio Schönholz, MD, looked at technique and device selection during Dr. Petrov s case broadcast from Bulgaria. Dr. White asked Dr. Petrov about the patient s blood pressure after balloon inflation which had indeed dropped prompting Edward Diethrich, MD, to ask Dr. White how he knew the patient s blood pressure may have Continued on page 5 Join Us Tonight! Cases Over Cocktails 6:15-7:15 p.m., Salon V Exhibits Open 7:45 a.m. 5:30 p.m. Registration 6:00 a.m. 6:00 p.m. Industry Lunch Symposia 11:45 a.m. 12:45 p.m. Oxygen Therapy: Its Role in CLI Management Salon V Sponsored by Kimberly-Clark Health Care New Frontiers in Treating CLI: The Tibiopedal Approach to Limb Salvage Salon VI Sponsored by Cook

2 2 MONDAY, FEBRUARY 10 icon 2014 Challenging Case Presentations Sessions Offer Unique Learning Opportunities Monday s educational offerings at icon 2014 kicked off with Challenging Case Presentations. Nine presenters shared their case reviews with the audience including case history, treatment options, complications, pre- and post-procedure imaging and teaching points. This is a very informative and educational format, said icon co-chairman Zvonimir Krajcer, MD, as he welcomed the audience. Presenters represented seven countries -- Ireland, Austria, Scotland, Korea, Czech Republic and Argentina -- in addition to the United States. A case presentation by Tarus Kucher, MD, drew comments from the session moderators, Dr. Krajcer and Claudio Schönholz, MD, as well as the audience. Dr. Kuchar s case was not only challenging due to the patient s medical problems, but her religious Tina Cohnert, MD, presents during Monday s challenging cases session. Speakers on Monday morning s Challenging Cases panel follow along with presentations made by their fellow speakers. beliefs as well a 66 year old female Jehovah witness. As he presented his case, Dr. Kuchar noted that her beliefs did influence the treatment approach the need to try to avoid a procedure that could result in need for a blood transfusion. During the procedure off-label use of a device Dr. Kuchar reported that a complication arose when, after the endograft was deployed, the top cap could not be removed. He explained the options now available to the team, with a hybrid approach chosen. He did report that the patient had post-procedure quad weakness, which she is receiving physical therapy for, but is otherwise recovering well. We really learn from these cases, said Dr. Krajcer. It could happen to everyone. You always have to think of option one, option two and option three. An attendee commented, I admire that you presented this case. Dr. Krajcer closed the session by thanking the presenters. I learn every time I see these type of cases presented, he said. Challenging Case Presentations will continue on both Tuesday and Wednesday mornings, beginning at 6:30 a.m. Tuesday s Live Case Schedule T hree live case presentations will be performed by Venkatesh Ramaiah, MD, at Arizona Heart, Phoenix, AZ. Transmission times are 8:00 a.m., 9:59 a.m., and 1:00 p.m.

3 icon 2014 MONDAY, FEBRUARY 10 3 CEA vs CAS: Speakers Look at Different Approaches Choosing between carotid endoaretctomy (CEA) and carotid artery stenting (CAS) was the topic of a number of presentations on Monday morning during the Stroke Intervention and Cerebrovascular Pathologies. The decision-making to select CEA or CAS is related to evaluation of the characteristics of the plaque and good knowledge of the patient s anatomy, said Giancarlo Accarino, MD. Hugo Londero, MD, discussed what can be done to get better results when performing complex carotid angioplasty. He stressed the need to obtain detailed patient evaluations, including an examination by neurologist. He reviewed what information different scans and tests will supply, including neurological exams; duplex scan; angio MRI-Gadolinium enhanced; MRI intracranial artery reconstruction, cerebral CT and MRI. Complexity does not exclude endovascular treatment, said Dr. Londero to conclude his presentation. Clifford Buckley, MD, provided the conservative vascular surgeon s opinion on treatment of asymptomatic carotid stenosis. I believe, in the right person s hand, each carries equal results, said Dr. Buckley. He said the questions that need to be asked include: What are the indications for treatment? When to treat? How to treat? Dr. Buckley reviewed the historical evidence for decision process and discussed the improved medical management options available today. Attendees enjoy the warm Arizona weather during the Monday morning coffee break.

4 icon MONDAY, FEBRUARY 10 New Techniques Present Both Exciting Possibilities and Complications M onday afternoon s CICE at icon session featured discussion about new technologies, including chimney endografts and the sandwich technique. As we have new technologies we will have new complications to think about, said Christopher Kwolek, MD, as he began to speak about chimney graft complications. We have to remember, what is the goal of intervention for AAA repair?, he said. The overall goal is avoidance of death due to rupture. He looked at the concerns that appeared 20 years ago when EVAR first appeared on the mar- Volume 21 n Number 1 n February 2014 Journal of Endovascular Therapy In this issue DEB vs. Standard Balloon to Reduce Recurrent Femoropopliteal ISR in Diabetics: The DEBATE-ISR Study Drug-Eluting Balloons for Salvage of Infrainguinal Bypass Grafts Volume 21, No. 1, Pages Nitinol Stents vs. Balloon Angioplasty for Very Long Femoropopliteal Lesions Photoablation Using the TurboBooster and Excimer Laser for ISR: The PATENT Study Early Recoil After Tibial Artery Angioplasty in CLI Patients Revascularization of Lower Limb CTOs With the TruePath: The ReOpen Study One-Year Outcomes After TAAA Repair With the Multilayer Flow Modulator When Not to Implant the Multilayer Flow Modulator CAS in Patients With Left ICA Stenosis and Bovine Aortic Arch Impact of Aortorenal Morphology on Renal Artery Stenting Aortouni-iliac Endografting as an Alternative to Conversion in Failed EVAR and more! February 2014 Visit Booth #30 to pick up a copy of JEVT and for a chance to win an ipad Mini! ket and he said those concerns remain today: durability, long-term outcomes and will the early benefits be sustained? The key is it s not one size fits all it s about patient decision-making, said Dr. Kwolek. One of the keys is to pay attention to outstanding imaging. Peter Lin, MD, shared tips and tricks when using chimney graft for renal revascularization. Chimney graft technology has gained a lot of enthusiasm over the past few years, said Dr. Lin. He reviewed the options available and decisions that have to be made regarding both access and device choice. One thing you need to consider is access, he said. We prefer to do a left brachial cutdown. Other considerations that Dr. Lin discussed included: Gutter seal vs true seal Difficult brachial access Radiation exposure Zvonimir Krajcer, MD, moved the discussion onto the sandwich technique. He also stressed the need for good imaging and becoming familiar with the patient s anatomy. He provided 10 tips, including securing fixation and the need to minimize the gutter leaks. Marcelo Curry, MD, discussed the use of sandwich technique to treat aortic arch aneurisms. As he reviewed the technique, he provided a detailed breakdown of his approach. CICE 2014 will take place April in Sao Paulo, Brazil. Visit for more information.

5 icon 2014 MONDAY, FEBRUARY 10 5 CLI: Speakers Stress Need for Patient Education Critical limb ischemia (CLI) was the focus of the NCVH at icon session on Monday afternoon. NCVH Chairman Craig Walker, MD, transmitted a live case from the Cardiovascular Institute of the South, Houma, LA. Dr. Walker s case proved to be both challenging and also a beneficial learning opportunity for attendees. Jeffery Ross, DPM, MD, spoke about the childhood obesity problem. He reported that one-third of all children are overweight or obese. Diabetes and the obesity epidemic is why we are doing so much endovascular surgery, said Dr. Ross. His presentation looked at the medical problems that are found in overweight and obese patients, the burden of diabetes and pre-diabetes and the dangers of those not aware they are living with diabetes are at risk for. Dr. Ross stressed prevention before intervention encouraging regular physical fitness routines. It really is the key, he said. When speaking about amputations, Alan Block, DPM, also spoke about prevention. The biggest problem is the education we re not providing patients, said Dr. Block, adding that 185,000 amputations will be performed every year in the United States. Amputations are not benign unfortunately the patients often become terminal. Dr. Block said that less than 20 percent of patients have an angiogram before amputation, and only 50 percent receive an ankle brachial index (ABI) test prior to amputation. How do you treat society,? he asked the audience. You come up with technology and treat the pathology, but you need to also treat the psychology of doctors treating this. We need to share the information brought out at this meeting with the entire medical community and our patients. James F. McKinsley, MD, co-national PI for DEFINITIVE LE Registry, presented one-year trial data. The DEFINITIVE LE TRIAL was a peripheral artery disease (PAD) study designed to confirm the value of plaque excision with the Sliver- Hawk and TurboHawk Systems in femoropopliteal and tibial-peroneal arteries. Eight-hundred patients were enrolled at 47 centers. One patient was excluded due to consent violations. There were two subsets, 598 claudicant patients and 201 CLI patients. Dr. McKinsley presented baseline demographics, periprocedural outcomes and quality of life outcomes. The endpoint was 95 percent freedom from amputation, he said. This is not a comparative trial but hopefully future studies will allow us to do that. For more information about upcoming NCVH conferences, visit icon Continued from page 1 changed before Dr. Petrov was able to share that with the audience. Experience, said Dr. White. During the session s question and answer period, Dr. Diethrich asked Clifford Buckley, MD, if he would have approached Dr. Petrov s case differently. I would have done an endarterectomy on this patient, said Dr. Buckley. But I don t have any object for stenting that individual. Attendees visit the Endologix (above) and Aptus Endosystems booths in the icon exhibit hall.