In 1977 when vascular surgery was in its infancy, Roger Greenhalgh, then a young surgeon, decided to organise one of the world’s first international conferences on vascular surgery, a meeting that would bring together the leading experts in the field to discuss and debate controversial issues of the day and set new challenges for the future. By 1978 this idea had become a reality, and the first Charing Cross International Symposium was held in a hospital lecture theatre.
Twenty-five years on and Roger Greenhalgh’s symposium continues to go from strength to strength. Having had an attendance of around 300 in the 1970s and 80s, the conference now attracts nearly 1,000 international vascular specialists, including vascular surgeons, interventional radiologists, interventional cardiologists and vascular physicians.
The original symposium format has remained similar and this year there will be two days of head-to-head debates on current ‘Vascular and Endovascular Controversies’ at Imperial College headquarters in London’s South Kensington. After challenging the available evidence the concluding audience vote will decide where the consensus lies.
In addition to the annual Charing Cross International Symposium and to mark the achievement of its Silver Jubilee, an exciting extra day on Sunday 13 April has been added to bring to London the inaugural Global Endovascular Forum. The purpose of this new forum will be to showcase advancements in this rapidly developing field and look into the future of endovascular therapies, as a panel of international experts highlights new technologies, new techniques and new horizons.
The first session of the Global Endovascular Forum is to be chaired by one of the greatest innovators of the endovascular era, Tom Fogarty, and will be looking at new endovascular horizons. Ted Diethrich will be presenting evidence that the ‘future of endovascular therapy is now’, Marc Feldman will decide whether ‘angiogenesis therapies can achieve clinical benefit’ and Geoffrey Gilling-Smith will explain recent progress in minimising endograft migration.
The second session of the forum aims to highlight new techniques and will open with remarks from Frank Veith on the ‘limitations of vascular and endovascular procedures’. This uncertainty is both matched and countered in a later talk by Maryland’s Frank Criado. He says in his talk on aortic stent graft issues that “the future of endograft technology for thoracic application is extremely bright, but several challenges and unmet needs remain, referring to the need for updating endograft design to meet the increasing needs of endovascular practitioners. Later in this session, Rodney White will examine the rapidly developing area of endograft technologies in the treatment of thoracic aortic aneurysms and dissections, and will state that “initial findings may lead to redefining the treatment of these lesions.
In the following carotid stent session, all the latest cerebral protection devices will be evaluated: Horst Sievert will give a report on developments in flow reversal, Peter Gaines will give an update on filters and Michel Henry will continue the debate over ‘vascular or endovascular’ when he tells us why carotid angioplasty and stenting with distal balloons means this practice is now “as safe as surgery. Jos van den Berg will then give the current low-down on the use of 3D rotational angiography.
The final session of the forum promises to display many of the new and innovative devices available today with a succession of talks on developments in endovascular technology. Krassi Ivancev will be giving a talk on branch stent grafts in which he will show examples of current devices and demonstrate their uses. Eric Verhoeven will speak on fenestrated grafts with contributions from Michael Lawrence-Brown on this and short aneurysm necks. One such use will be a technique that prevents embolization of the internal iliac artery and the subsequent stent graft extension during AAA. He will also demonstrate an alternative to covering the left subclavian artery with the main stent graft during type B dissection by using a branched stent graft to seal it instead. Also in this session Bernd Heublein will be discussing the potential of biodegradable stents as vascular implants, and Peter Gaines will be reviewing available data on coated stents for coronary intervention and their potential for peripheral use.
Alexander de Vries will be introducing a new in situ polymer graft developed in the Netherlands which might be used in a new technique to “counter endoleak, kinking and migration complications after endovascular treatment for abdominal aortic aneurysms, and an exciting last minute entry by Frans Moll will demonstrate a second generation biological venous valve that will be entering into a phase one trial next spring which hopes to conquer chronic valve insufficiency.
The Charing Cross Symposium itself will follow the events of the Global Endovascular Forum on 14 and 15 April and as in so many previous years, promises something of a spectacle.
Areas to be covered in next year’s debating programme will include carotid, aortic, thoracic aortic, abdominal and renal, lower limb, and venous controversies. Opening discussions on the first day will include more general topics within vascular surgery, such as ‘Open audit is a waste of time'(Janet Powell and Peter Harris), ‘Endovascular AAA repair should be carried out as a day case procedure'(Jacques Bleyn and Brian Hopkinson), and ‘Endovascular procedures belong in a sterile operating suite'(Ted Diethrich and Anna-Maria Belli).
Of the carotid controversies, Alison Halliday and Georgio Biasi will discuss whether there is a mandate for intervention in asymptomatic carotid disease. Alison Halliday will be arguing the case that, to date, no trial has shown that stenting prevents strokes in asymptomatic cases, whilst Giorgio Biasi argues for the necessity of identifying high-risk subgroups on the basis of the features of the carotid plaque, disputes the ethics of automatically excluding asymptomatic patients presenting with significant stenosis from surgical treatment, and explains that not all asymptomatic patients are equal.
David Bergqvist and Peter Taylor will present the case for and against intervention before CABG being unnecessary, whilst the four-strong team of Peter Gaines and Jay Yadav, and Phillipe Piquet and Patrice Bergeron will debate whether carotid stenting should always be performed with cerebral protection.
“Type 2 endoleaks are clinically unimportant,”says Krassi Ivancev in the first of the aortic endovascular controversies, as “one third of them spontaneously resolve and the majority remain unchanged following EVAR. Geoffrey White opposes the motion. Other debates in this field will include whether ‘commercially available systems render emergency aneurysm repair an option'(Frank Veith and Michael Wyatt), and if ‘Supra renal fixation of stent grafts is a disadvantage'(Dieter Raithel and Michael Lawrence-Brown).
Two giants of the radiology world, Dierk Vorwerk and Jim Reekers, will clash in the lower limb controversies session as they dispute whether stents are required in femeropopliteal angioplasty or if angioplasty is sufficient on its own. In a later debate ‘Thrombolysis is irrelevant in the treatment of arterial graft occlusion’, Alun Davies stresses the superiority of surgery over lytic therapy in terms of ongoing and recurrent ischaemia and adverse clinical outcome, whilst the opposer, Kenneth Ouriel, finds lytic therapy useful as an adjunct, depending on how well it is performed.
Once again, the 2003 symposium will provide an outstanding three days of world-class discussion next April that promises to make the Charing Cross Jubilee year an event to remember.
For more information and full programmes for both of these events and details of how to register please go to the Charing Cross Symposium.