9th Ajaccio Workshop on Endovascular Surgery

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Every year in June the workshop in Ajaccio (AIWES) provides vascular specialists with a comprehensive, practical and up-to-date look at all aspects of endovascular surgery.

The meeting takes place in a warm and relaxing environment where there is more discussion than the didactic lectures that you often have to endure at a typical congress. There are no live cases, no trade exhibitions and you feel as though you are among a small group of friends.

The organisers were Patrice Bergeron, Lucien Castellani and Torben Schroeder with the enthusiastic support of Geoffrey Gilling-Smith who put much of the programme together.

Once again the Ajaccio meeting set out with the ambitious objective of trying to establish a consensus in the endovascular field and there were a number of sessions that sought to establish this.

Last year the theme was “Selection for Endovascular Repair of Abdominal Aortic Aneurysm – Basic Guidelines”and this year’s meeting started with a review of the highlights of the 2001 workshop with particular emphasis on patient and graft selection. Frank Veith presented data on a large group of patients considered to be neither candidates for open repair nor EVAR in whom the long-term rupture rate was only 4%. This led to a discussion on whether the risk of rupture is generally lower than claimed. Jim May presented the long-term results of endovascular repair that showed a large variation in the number of patients surviving more than five years after EVAR. He also presented the early and late conversion rates for these patients which all relate to either first or second generation endografts.Chris Liapis then reviewed the natural history after open repair and in particular, the significance of the ADAM and UK trials on small aneurysms. The issue of whether there is increased risk of rupture in women was raised but it was felt that it would be ill-advised to draw conclusions for subgroups of patients as this was not in the original study design.

The next discussion was on the relevance of endotension and intrasac pressure to everyday practice. This threw up more questions than answers. Geoffrey Gilling-Smith presented three ongoing studies on sac pressure measurements. The first study is measuring the pressure in the thrombus during open repair before clamping, the second is measuring sac pressure for three days after EVAR and the third is measuring translumber/transcutaneous sac pressure in selected patients. These studies indicate that sac pressure is variable and compartmentalised and that there is a variation in sac pressure measurements between patients. At the end of the discussion many of the questions on endotension remained unanswered.

The focus on endovascular aneurysm repair continued with an analysis of quality of life after endovascular repair as well as a review of the data on cost benefit. Apart from the startling evidence based insight that “sex is better at one month after EVAR than open repair, the conclusions were that EVAR was a more expensive procedure as the higher costs of follow-up and the need for secondary intervention outweighed the fact that EVAR required a shorter hospital stay and resulted in a faster recovery. Frank Vermassen pointed out that the freedom of secondary intervention after EVAR at seven years was only 45%.

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