“Radiation will be a thing of the past”: FORS in the spotlight at CX 2021

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Clockwise from top left: Roger Greenhalgh (London, UK); Bijan Modarai (London, UK); Gustavo Oderich (Houston, USA); Marc Schermerhorn (Boston, USA); Konstantinos Spanos (Larissa, Greece); and Enrico Rinaldi (Milan, Italy).

Opening the Charing Cross (CX) 2021 Digital Edition (19–22 April, online), experts deliberated crucial controversies in the abdominal aortic space. Discussion emphasised the potential of Philips’ Fiber Optic RealShape (FORS) technology to reduce radiation and ease technical success, with moderator Gustavo Oderich (Houston, USA) suggesting that “radiation will be a thing of the past” thanks to this new technology. Other key takeaways were a ringing endorsement that endoanchors have a part to play in the treatment of challenging necks, and consensus among the panel that parallel grafts should be used as little as possible in this hostile anatomy. 

All Abdominal Aortic sessions are available to view on demand. Click here to register and access the recordings.

FORS addresses “major area of need” in abdominal aortic surgery

Marc Schermerhorn (Boston, USA) gave a presentation on the “disruptive” technology of FORS, which opened a panel discussion on the topic of radiation. Oderich stated that FORS “addresses a major area of need, which is the ability to look at the anatomy on any view we want without being radiated”, highlighting that the technology offers both an ease of technical success and parallel reduction of radiation. Looking ahead, he posited: “Radiation is going to be a thing of the past”.

Following Schermerhorn’s presentation, a Philips’ Meet the Experts session offered a deep dive into FORS technology, with a panel of users and experts discussing latest clinical experience and three-dimensional (3D) catheter agnostic guidance.

Registrants can view Schermerhorn’s presentation on demand here and Philips’ Meet the Experts session here.

Endoanchors in challenging necks come of age

In a Podium 1st presentation, William Jordan (Atlanta, USA) revealed preliminary five-year data from the primary arm of the ANCHOR registry (Aneurysm treatment using the Heli-FX EndoAnchor system global registry). This is a multicentre, prospective study designed to capture real-world usage of the Heli-FX EndoAnchor system (Medtronic) in patients with challenging AAA anatomy, particularly those with hostile aortic neck anatomies. Jordan concluded that, out to five years, patients with hostile necks “may have acceptable durability when the EndoAnchor fixation method is used, particularly at the index operation”.

Registrants can view this presentation on demand here.

Showcasing the practical use of endoanchors in the challenging neck anatomy, Giovanni Pratesi (Genoa, Italy) presented an edited case, with postoperative computed tomography angiography (CTA) showing complete aneurysm exclusion in a challenging proximal aortic neck.

Registrants can view this edited case on demand here.

Audience vote against use of standard EVAR in majority of challenging necks

A CX Debate addressed another pressing issue regarding hostile neck anatomy—that being whether standard endovascular aneurysm repair (EVAR) can be used in most challenging necks. Colin Bicknell (London, UK) stood for the motion, while Vascular Society of Great Britain and Ireland (VSGBI) president Michael Jenkins (London, UK) put forward the counterargument.

“There is significant, successful innovation to ensure short-term sealing and prevent long-term complications,” argued Bicknell, who resolved that EVAR is therefore appropriate for “most” patients with AAA who prefer this approach. Jenkins, on the other hand, contended that standard EVAR cannot be used in most challenging necks “because it does not work”. He elaborated: “It is outside IFU [instructions for use], aortic neck dilatation leads to loss of seal, and sac expansion causes positional change and effacement of seal zone.” He added that while adjuncts may help transiently, they are not durable. “What may have been heroic 10 years ago, perhaps maverick five years ago, now is criminal”, Jenkins concluded.

CX polling results

Following the debate, polling revealed that 71% of the CX 2021 audience disagreed with the motion that standard EVAR can be used in most challenging necks.

Registrants can view this debate on demand here.

Consensus among panel that parallel grafts should be used as little as possible in hostile necks

Also addressing a challenging neck controversy, Alexander Zimmermann (Zürich, Switzerland) gave a presentation on parallel graft use in the anatomy of a hostile neck, focusing in particular on “disappointing” clinical results thus far. He concluded that, in the majority of cases, he aims to “stay away” from using such grafts in challenging necks; the moderators were in agreement, with Ian Loftus (London, UK) voicing that he would only use parallel grafts in “very selective emergency cases” and Roberto Chiesa (Milan, Italy) stating that he uses parallel grafts as infrequently as possible.

Registrants can view this presentation on demand here.

All CX 2021 content is available to view on demand. Click here to access the recordings.


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