It's Still On! Now in Miami Beach, Florida! The First International CLI Summit on Lower Extremity PVD and Critical Limb Ischemia

In lieu of the horrible events that have recently occurred in New Orleans due to Hurricane Katrina, what is the current status of the national New Cardiovascular Horizons, Renaissance Summit, and CLI Summit meetings?

In the face of the single largest natural disaster that this country has ever experienced, it is hard to focus on anything 6–8 weeks from now, especially something educational and not life-or-death. But we must. Life goes on, and so does education. Some hard decisions had to be made. In the true spirit of education, the executive committees of all three events have adopted the slogan, “Yes, it’s all still on!” As a matter of fact, we will move the entire 3-in-1-conference venue including the inaugural international CLI Summit, New Cardiovascular Horizons, and the Renaissance Summit 100% intact to the lovely Intercontinental Hotel in Miami Beach, Florida. The exact dates and agenda will remain the same including live cases, satellite symposia and workshops. We were truly blessed to have one of the best hotel facilities in the country to have availability for our conference on such short notice. Our registrations and industry support have been tremendous and we hope the unfortunate need for a change of venue from New Orleans to Miami Beach will not be an inconvenience to registrants, and that they will continue to show their loyalty under these unprecedented circumstances. The Intercontinental Hotel facilities are superb, and we’re getting great support from all of South Florida and beyond. We are particularly happy that the inaugural international CLI Summit will remain intact with live limb salvage cases. Yes, we will still showcase live cases. Our abstract response has been great and there is still time to submit abstracts. We have literally received thousands of calls and emails from our faculty and industry and all express their concern but also stand ready to enthusiastically do whatever it takes to continue with the conference. In the true spirit of education, we will work hard to duplicate the great “Horizons” events of the past few years in New Orleans, and we want everyone to know “Yes, it’s all still on!” in Miami Beach, same dates, same time.

What would you like to share with the physician or professional who has never had the chance to attend the New Devices Seminar?

New Cardiovascular Horizons (NCVH) began in 2000 as a small, local, multi-disciplinary meeting. I would stress “multi-disciplinary,” because that’s the way that our group, Cardiovascular Institute of the South, practices. We treat our patients from head to toe. The first NCVH meeting was so successful that we grew and spread to all disciplines that were primarily involved with the treatment of cardiovascular disease, especially peripheral vascular disease (PVD). In its second and third years, NCVH expanded into podiatry, wound care education, and sessions for the cath lab tech, RN and whole range of cardiovascular health care givers. We also started the Masters and Legends program and honored our achievement award winners, who span various disciplines. Our first award winner was Julio Palmaz, a radiologist, and then the next year, Edward Diethrich, a surgeon. In 2003, the award was presented to Martin Leon, a cardiologist, and in 2004, to Thomas Fogarty, a surgeon. This year, we are presenting the achievement award to John Simpson, a cardiologist. These are the true “living legends” of our discipline. The faculty we invited the first and second years gave excellent reviews and they liked the concept of a multi-disciplinary approach because no one else was doing it. Their positive response really enabled us to grow and to put together our Masters and Legends program. This is a single day that features the true living masters and legends in the cardiovascular and especially endovascular fields. It struck me that our specialty is so new that the true legends are still living and with us today. Instead of having these legends speak only for 8–10 minutes, we give them all 30 minutes to develop an in-depth presentation. No one has ever put together that kind of a lineup of physicians at one time, and it has been very well received. Simultaneous with our positive cardiovascular faculty feedback, the podiatry, wound-care and all of the other disciplines faculty and attendees also provided great feedback. As a result, we were able to attract the leading physicians and specialists in each of the non-cardiovascular specialties as well, with equally noted faculty like Larry Harkless, David Armstrong, Andrew Boulton and John Steinberg, who are all “legends” in their respective disciplines. Likewise, we were able to do the same thing with nursing, primary care, internal medicine and endocrinology. The other secret was that we had excellent support from industry, because no one else was doing this type of meeting. As a result, NCVH grew from 500 to over 3500 attendees in only a five-year period.

Have you seen the field change drastically in the past five years in a way that justifies creating NCVH as a multi-disciplinary conference

Absolutely. Especially in the endovascular field. Five years ago, we were thinking about carotid stenting. Now it’s FDA-approved. Five years ago we were thinking about EVAR for aneurysms. Now it’s routine. Five years ago there was no drug-eluting coronary stent. Now, again, it’s routine. Five years ago, there was no atherectomy device, no PolarCath, and laser was there, but no one really understood it. Similarly, we didn’t have the same wires and the same chronic total occlusion devices, so the endovascular treatment of the superficial femoral and infrapopliteal arteries and critical limb ischemia was almost non-existent. I just mentioned at least five new technologies that did not exist on the market only 3–4 short years ago. In the wound care and pharmaceutical fields, we now have better drugs, better local wound care therapies, and CTA. CT angiography was not even available three years ago. Now there is a whole exploding field also in the diagnostic and imaging areas for cardiovascular diseases and CLI.

The year 2005 also marks two important “firsts” for New Cardiovascular Horizons: the first CLI International Summit and the first Renaissance Summit.

Five years ago, we didn’t even understand critical limb ischemia (CLI). CLI is what I’d call a “hot topic.” Right now, we understand more about it, we’re enhancing that awareness further, and we now have a “tool box” to treat CLI that we never had previously. Five years ago, we had primarily a pathway to amputation. Today, it’s important that we develop a pathway to limb salvage, because it’s possible to diagnose CLI and treat it much differently. To reflect this developing reality, in our sixth year of building upon NCVH, we’ve added the inaugural, international, multi-disciplinary CLI Summit that will immediately precede the NCVH meeting. The CLI Summit has been very well accepted by the U.S. and international communities. We will have multiple, live limb-salvage cases, and a world-class faculty of cardiologists, surgeons, wound-care specialists, podiatrists, orthopedic surgeons and all who are interested in achieving limb salvage. The second inaugural event at NCVH will take place Saturday, October 29, with the Renaissance Summit. This is the first organized event in which our goal will be to provide catheter-based training to the cardiothoracic surgeon and vascular surgeons by providing a series of visionary and proactive lectures provided by Drs. Diethrich, Palmaz, Mack, Criado, Robicsek, etc. This will be followed by an entire half day dedicated to providing practical, hands-on workshops and medical simulation for the surgeons, introducing them to the culture of endovascular care.

Can you talk about the numerous live cases that you’re going to be offering throughout the meeting?

We will have live cases during the CLI summit on Wednesday, October 26. On Thursday, October 27, we will have strictly limb salvage cases in which we will concentrate on the SFA and the infrapopliteal vessels. We will showcase all of the new crossing techniques for the difficult case, as well as some of the newer stents, the Excimer laser, SilverHawk atherectomy device, PolarCath, as well as some of the newer crossing wires and access catheters, such as the Intraluminal Therapeutics SafeCross wire and the BioCardia Morph catheter, and all of the new technologies that we didn’t have three years ago that now allow us to perform CLI cases. On Thursday and Friday (October 27–28), we will also have live cases dealing with PVD in general: iliac artery stenosis, renal artery stenosis, celiac and SMA disease, subclavian artery stenosis — essentially, the entire spectrum of endovascular treatment for PVD from head to toe (excluding CLI, which we will concentrate on for the first two days).

How are you integrating all the various topics and disciplines within the meeting?

For the main NCVH event, Thursday through Saturday, we will also have sessions for cardiology, primary care, internal medicine, endocrinology, podiatry, RN-NP, wound care, and cath lab technologists. Faculty from all of these disciplines who are involved in cardiovascular diagnosis and care will be talking about topics such as what’s new on the horizons of cholesterol management, diabetes care, congestive heart failure, rhythm management, and all other aspects of cardiovascular disease treatment and prevention. We’ll also have multiple satellite symposia on CTA, new contrast agents, and especially, new treatments in wound care. There’s one very exciting symposium that will introduce a new wound care treatment that is called Microcyn or Dermacyn. This is an exciting new topical treatment that we think is going to make a big difference in fighting bacterial infections in diabetic foot ulcers, CLI, critical wound ischemia, and chronic wound healing, with far-reaching potential uses in burns, respiratory and skin infections. This is a new non-toxic, “super-oxidized” water that appears to have tremendous antimicrobial activity against all bacteria and spores, including MRSA. It has very encouraging early results from Mexico and Italy in all kinds of wounds, including diabetic foot ulcers, burns, CLI and venous ulcers. To date, Microcyn has been found to be non-toxic to living human cells. U.S. trials are being organized and preliminary results are due to be presented at our conference. The other potential healthcare benefits of this technology are staggering when considering that chronic infections play a huge role in almost all diseases from head to toe, and have a staggering impact on our hospitals and entire healthcare system. Saving a limb takes more than the revascularization. We’ll have faculty at the meeting from the disciplines that provide the revascularization and blood flow. We’ll have the cardiologists, the surgeons and the interventional radiologists. We’ll also have the physicians and the clinicians there who diagnose the disease beforehand and handle the patient after the diagnosis is made: the primary care physicians, the wound care specialists, the podiatrists, the PAs, and the nurses. If we are to make an impact on the treatment of CLI, we must have all disciplines involved. NCVH will also showcase the new ways to diagnose cardiovascular disease, and especially PVD, with CTA. We’ll have the disciplines there who want to aggressively revascularize, but then after revascularization the patient will still need additional therapy in most cases, and this will include the podiatrist, the wound-care specialist, and the entire “CLI team.” Previously, there has been a disconnection between all of these specialists, all of whom are necessary to save a leg. We put all of these disciplines together in one environment, at one conference. The educational agendas are set up uniquely to allow attendees to pick and choose between each of these sessions, which are designed to showcase what’s new on the horizon in the treatment of cardiovascular diseases. On Saturday, we will specifically dedicate a great part of the day to practical, hands-on workshops and wet labs in which the attendees can really get “hands-on” involvement with most of the new technologies. There will be a lot of medical simulation as well. The inaugural “Renaissance Summit” will be an entire half-day workshop for the cardiothoracic and vascular surgeons, introducing them to new catheter-based treatments. Specific practical workshops will be set up for novel treatments and therapies, and we’ll have multiple wound-care workshops. The meeting is designed to flow from the CLI Summit into New Horizons and then Saturday (October 29), the final day, with an emphasis on practical workshop activities.

Your group, the Cardiovascular Institute of the South, is quite unique. Can you talk about how it informs and reflects the multi-disciplinary and cutting-edge nature of NCVH?

Twenty-two years ago, Dr. Craig Walker started the Cardiovascular Institute of the South (CIS). At that time, he practiced as a single physician at the Houma Heart Clinic. His vision was to create a large cardiovascular practice in a very small and almost rural area. How could he do that, almost alone and without a surgeon and at that time, without even a cath lab and a hospital supporting him? He quickly realized that he needed the surgeon as his full clinical and equitable partner, and that he had to treat the patient from head to toe, because there was no other support system in place in Houma for this type of program. It was with those concepts in mind that he had the vision to start CIS. As a traditionally trained cardiothoracic and vascular surgeon, I came to Louisiana myself for the same reason. I wanted to treat the patient from head-to-toe, and I wanted to have a clinical and equitable relationship with the cardiologist because it was best for patient care. So with those humble beginnings over 20 years ago, and with those two concepts, the Houma Heart Clinic began to grow into the CIS, and we grew from one center in Houma to approximately a dozen different centers and clinics all across south Louisiana. For our patients to have an optimal outcome, we had to develop a multi-disciplinary approach from the onset and we learned to get the podiatrists, the primary care givers, the wound care specialists involved, especially if we were to achieve limb salvage. Since this approach took out a lot of the politics between cardiologist and surgeons in our daily practice and we didn’t have what I would call the “turf wars” between the disciplines, this enabled our group to really focus on and aggressively treat the disease. We were able to get into a lot of the early clinical device trials and use our experience and our large practice to learn how to treat this disease. When endovascular treatments for PVD became available well over a decade ago, we began to utilize that in our practice because we had the surgeons and cardiologists on the same team. Therefore, we could offer these new treatments without a lot of the other problems that other groups might have. One of the other things I’ve always said is that the day-to-day challenge should not be fighting between the cardiovascular disciplines; the real challenge and fight is and should be treating the disease, because the disease is “tough enough” in and of itself. As the result of our practice approach, we could concentrate on patient care. What we wanted to do next was to provide this kind of education to our colleagues and physicians locally. Over a dozen years ago, CIS began to have very small, local meetings. We had a Latin American program in which we focused on providing a lot of this type of education and patient care in Mexico and it was very successful. The way that we developed our practice and the way that we took care of our patients is exactly the way that we designed New Cardiovascular Horizons. I have to personally thank Dr. Craig Walker for his insight into patient care and leadership in building this type of creative practice that has allowed our practice to grow and flourish, provide outstanding clinical outcomes for our patients, and the freedom and support to create such a unique educational event this October 26–29 in Miami Beach. We initially designed this conference so that the entire cardiovascular team could come to New Orleans. The “team” includes the surgeon, the cardiologist, the interventionalist, the primary care givers-referring clinicians, the wound-care specialist, the nurse, the podiatrist, and the cath lab tech. We want them all to come to our meeting because we have an agenda for each of these members of the team. Ideally, these team members would come and spend the weekend, share in our unique education, have an awful lot of social fun, and also have a lot of time to coordinate and network with each other that they probably couldn’t get back home, let’s say in Jackson, Mississippi, for example. After the meeting, the members of the team go back to their facility with a new perspective on patient care and their community is changed forever. The team aggressively starts to treat the disease in a different way, the head-to-toe way which we years ago developed as our CIS method of cardiovascular practice. Little by little, year after year, we believe our conference has been making this impact regionally, nationally, and now we hope, internationally.