Endovascular Essentials Symposium Covers Clinical Pearls and Practical Tips

ISET 2019 begins with the Endovascular Essentials symposium on Sunday, January 27th. The symposium focuses on practical tips and clinical pearls that attendees can implement in practice, and it includes an interactive case-based session, a live vascular physical exam, and a review of the latest clinical trial data. Ripal Gandhi, MD, of Miami Cardiac & Vascular Institute will be both moderating the symposium and presenting. In this Q&A, Dr. Gandhi shares highlights of the Endovascular Essentials symposium.

Tell us about the development of the Endovascular Essentials symposium.  

The goal of this session is to provide a comprehensive overview of state-of-the-art disease diagnosis, management, tips, and tricks for all aspects of vascular disease. The session was developed by our program directors in conjunction with the Society of Vascular Medicine and will be useful to people in all fields related to endovascular therapy, whether interventional radiology, interventional cardiology, vascular surgery, vascular medicine, or any other specialists who are involved in the clinical evaluation and therapeutic treatments of vascular disease.

What types of topics will be covered?

The presenters will cover various important clinical pearls as well as technical tips and tricks that can be useful for all levels of practitioners. Patients are increasingly being treated through endovascular means. However, the key to treatment is determining when an endovascular approach is appropriate, when surgery is necessary, or when a combination approach is needed. Furthermore, some patients are best managed with medical therapy alone.  For example, the treatment of acute mesenteric ischemia has changed over the past several years and a presentation by Frank Arko, MD, will address scenarios in which an endovascular approach is appropriate. While acute mesenteric ischemia has traditionally been considered a surgical disease, endovascular therapy does have a role in the modern day and this will be highlighted in this presentation.

Building off the talk by Dr. Arko, there will be a presentation by John Angle, MD, of the University of Virginia. Dr. Angle will be covering technical tips and tricks in managing mesenteric ischemia, specifically chronic mesenteric ischemia. Many of these patients can be difficult to manage from a technical approach, and attendees will have the opportunity to learn from a physician with significant experience in treating this disease. These types of practical takeaways are hard to find in the literature and best come from someone with extensive clinical experience.

What are some other presentations included in the Essentials symposium?

Chris Metzger, MD, will be presenting on treatment of proximal DVT, which is a very relevant topic in the post ATTRACT trial era. Dr. Metzger will share his experience regarding who should be treated and why they should be treated. He will discuss identifying the significant number of appropriate patients who would still benefit from treatment with proximal DVT, despite the negative results from the ATTRACT trial.

We’re starting the Essentials session with various topics on medical management of patients with peripheral arterial disease (PAD), which is going to be given by Joshua Beckman, MD, MsC, as well as a session on systemic cardiovascular risks in PAD patients, given by John Bartholomew, MD. Assessment of lower extremity ulcers and basics of wound care will also be discussed, as these are very fundamental topics that every practitioner should understand.

The key to the Essentials session is that we have real experts talking on these topics, and they can break down the information so that the audience can walk away with practical, helpful tips for managing patients, as opposed to getting into the weeds with details that might not be useful.

What will be offered in the afternoon sessions?

The afternoon sessions are extremely valuable. Kenneth Rosenfield, MD, will be speaking on the evidence-based treatment algorithm for massive and submassive pulmonary embolism. It’s a very relevant topic. One of the hottest areas in endovascular therapy is the management of pulmonary embolism and the use of minimally invasive therapies to treat submassive and massive pulmonary embolism. Dr. Rosenfield is one the of the pioneers of the field and one of the first to create a pulmonary embolism response team (PERT). Other institutions have adopted his approach, including MCVI and Baptist hospital. His session will include treatment strategies as well as updates on continuously evolving technologies and techniques.

Dr. Rosenfield’s talk will be followed by a case-based session on pulmonary embolism with experts including John Moriarty, MD, from UCLA; Akhilesh Sista, MD, from NYU; Victor Tapson, MD, from Cedars-Sinai Medical Center; and Allan Stewart, MD, who is head of cardiac surgery at our own institution.

I’m also looking forward to an afternoon session by John Kaufman, MD, MS, from Oregon State Health, focusing on treatment of chronic venous occlusion. We are going to see more advances in the future regarding treatment of chronic venous disease. Industry is investing in this space and developing new technology and tools designed specifically to treat chronic venous disease.

As part of the Essentials symposium, you are presenting a session. Can you give a short preview of what the audience can expect to learn?

I’m going to be presenting case-based aortoiliac disease, and we will have several people on the panel for discussion, including Parag Patel, MD; Darren Schneider, MD; and William Gray, MD. It is useful to have a multidisciplinary discussion and therefore we specifically chose a panel consisting of an interventional radiologist, interventional cardiologist, and a vascular surgeon.  I’m going to start with a basic case, probably either a common external or internal iliac artery occlusion, and then later in the session present some complications. We will discuss patient selection, clinical data driven endovascular and surgical treatment options, and when each option should be chosen.

We will go through the actual technique, such as whether to use an ipsilateral common femoral approach, a contralateral common femoral approach, or an upper extremity approach. Crossing techniques will also be covered, including best techniques, use of guidewires or catheters, and whether crossing devices should be used. Following crossing of the lesion, we’ll talk about both true lumen as well as subintimal crossing and utilization of tools in the case of subintimal crossing.

Finally, we’ll discuss the optimal treatment of a chronic total occlusion. Should we use a self-expanding stent or a balloon-expandable stent? Should we be using bare metal stents or covered stents? What devices have the most data supporting them?

Complication management will be an important part of the session. Any practitioner treating patients with aortoiliac or occlusive disease should be able to treat complications, especially significant and life-threatening complications such as hemorrhage and dissection.

Can you tell us about the live physical examination?

One of the favorite parts of this symposium is the live physical examination, which we’ve included for the last several years. Michael Jaff, DO, presents this session, and we actually have a live patient who comes in and graciously gives his/her own time for the benefit of physician education. Unfortunately, in this day and age physicians are often not properly trained specifically in a vascular physical examination. That’s why we developed this session dedicated to a vascular physical exam given by a true expert in the field. Dr. Jaff shares clinical pearls that are hard to find in any textbook or article. Attendees will gain firsthand knowledge of the physical examination from somebody who has been doing this for many years and deeply understands the nuances of a dedicated vascular physical examination.

Is the Essentials symposium geared towards early career or seasoned practitioners?

We want this symposium to be helpful not only to early-career practitioners, such as trainees, residents, and fellows, but also to seasoned and experienced practitioners who want to brush up on some of the fundamentals of vascular diagnosis and management. The Essentials symposium will also be useful to those who haven’t performed certain procedures or treated certain disease entities regularly. This is a very comprehensive program that covers the majority of the key aspects of vascular disease.

At ISET we are committed to providing the most advanced and state-of-the-art education and training to the next generation of vascular specialists. ISET’s commitment to training future colleagues is one of our major goals, and in keeping with that goal, the faculty for the Essentials session are the world experts in all aspects of vascular disease. It’s a great opportunity for residents and fellows to meet and network with these experts and world authorities, as well as like-minded colleagues. Training the next generation of vascular interventionalists is our goal and is ultimately our legacy, so we take this very seriously.