Debates will shed new light on controversies in the treatment of aortic disease at the 2024 Charing Cross (CX) Symposium, alongside practical sessions with a focus on techniques and technologies in both aortic endovascular and open surgical repair.
Running over the full three days of the symposium, the comprehensive aortic programme at CX 2024 opens with aortic techniques and technologies on day one, followed by a full day focused on aortic arch and thoracic aortic controversies, and finishing with sessions covering juxtarenal and abdominal aortic aneurysm controversies, alongside advanced imaging and radiation reduction on the final day.
CX has a three-year cycle of raising vascular and endovascular controversies in order to challenge the available evidence and to be able to reach a consensus after discussion with an expert audience. “It is a controversies year, so the focus will be on debate,” says CX Executive Board member Tilo Kölbel (University Heart Center Hamburg, Hamburg, Germany).
The treatment of uncomplicated acute type B aortic dissection will be the subject of a great debate during Wednesday’s thoracic aortic controversies session, during which Kevin Mani (Uppsala University, Uppsala, Sweden) and Hence Verhagen (Erasmus Medical Center, Rotterdam, The Netherlands) will put forward their case that best medical treatment remains the standard of care, whilst Christoph Nienaber (Royal Brompton & Harefield Hospitals, London, UK) and Firas Mussa (McGovern Medical School, Houston, Texas) put forward the counter argument.
Gustavo Oderich (University of Texas Health, Houston, USA) and Eric Verhoeven (Paracelsus Medical University, Nuremberg, Germany) will debate the use of self-expandable covered stents versus balloon-expandable stent grafts in branched endovascular aortic repair later that day.
“It is of great interest to the community to understand the pros and cons for the use of balloon- versus self-expandable stents in branched repair,” says Kölbel of the significance of this debate. “Branched aortic repair is being done in increasing numbers, with more off-the-shelf devices being available for use in North America and in Europe. There are basically two different schools in vascular surgery. One uses balloon-expandable stents, which may be less flexible, and one uses self-expandable stents, which are more difficult to use because they need more profile.”
This session will also see Martin Austermann (St Franziskus-Hospital, Münster, Germany) and Nikolaos Tsilimparis (Ludwig-Maximilians University Hospital, Munich, Germany) trade views on the justification for prophylactic spinal drainage for thoracoabdominal endovascular repair.
“Spinal cord ischaemia is the most devastating outcome of complex aortic repair,” comments Kölbel. “One of the best ways to prevent that from happening is spinal drainage and it has been a recommended part of guidelines for many years. Recent guidelines have downgraded that recommendation, indicating that there is more controversy over whether the downsides and complications of spinal drainage still allow for prophylactic use.”
Polling at the end of each debate will give a clear indication as to where the CX community stands on each of these issues.
Alongside these sessions, Tuesday’s techniques and technologies session will focus on specific techniques in open and endovascular repair. Highlights include an edited case, presented by Oderich, which will cover transcatheter septotomy in chronic aortic dissection.
A podium first presentation—one of many to feature throughout the three-day aortic programme—during Thursday’s advanced imaging and reducing radiation session will explore how operator position influences radiation dose.
