Sicilian Vascular Symposium

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As it has been before, the aim of this two-yearly event was to stimulate discussion on controversial and debated issues in vascular surgery. In particular, focusing on changes in therapeutic indications and strategies in fields widely affected by recent technical improvement and an increase of basic knowledge.

The Chairman of this event was Professor Francesco Spinelli. He and his team, the department of Vascular Surgery at University Hospital in Messina, organized this year’s meeting.

The congress was opened by the introduction of the President of Italian Society of Vascular and Endovascular Surgery (SICVE), Professor Raimondo Pistolese, Rome. It was followed by a forum on “Current Trends, Challenges and Ethics in Vascular and Endovascular Surgery”, chaired by Dr Benedetto Marino, Rome, with participation of Dr Jean Michel Cormier, Paris, and Sir Peter Bell, Leicester.

Dr Cormier pointed out the worrying decrease in number of vascular surgery trainees due to the lack of attraction of the specialty. In spite of a heavy work and physically exhausting conditions, the vascular surgeon has undergone a continuous worsening of quality of life.

To make the specialty more attractive to young surgeons, Cormier advocated a better integration of private surgeons in university hospital departments and the organization of a vascular team allowing elective training for endovascular techniques and laparoscopy, reducing constraints and allowing better allocation of technical resources.

From the Hippocratic Oath and the Declaration of Geneva, Sir Peter Bell recommended the observation of ethics in choosing the right treatment and in giving the right information to patients in the “temptation island” of new and apparently unharmful devices. Only the creation of mandatory registries and a correct evaluation of randomized controlled trials could help vascular surgeons to fulfill their ethical duties.

The main topics treated were the role of carotid artery stenting versus open endarterectomy, with three sessions devoted to the evolution of carotid and supra-aortic surgery.

Five sessions were dedicated to the treatment of thoracic, thoracic-abdominal and abdominal aortic disease, with much attention given to endovascular and laparoscopic techniques. These are currently regarded as alternative approaches to open surgery, but many of the speakers reported their experience in using them as a supportive tool to extend indication and increase ability to treat patients less invasively.

Among the many outstanding contributions, Dr Edouard Kieffer, Paris, reported his experience in hypothermic circulatory arrest in treatment of type B aortic dissection and Professor Piergiorgio Cao, Perugia, made the point on “the state of art” in side-branch technology in EVAR.

Dr Vicente Riambau, Barcelona, described the “EVAR Scenario” after 10 years of experience, claiming that a proper selection of patients yields to a “no conversions” series.

Dr Giovanni Torsello, Muester, Germany, reported the German Multi-centers study of late results with Talent endoprosthesis. The final outcome of patients was 2% aneurysm rupture during the follow-up and 17% of late mortality with 0.6% of aneurysm related mortality.

In the treatment of critical limb ischemia, Professor Andrea Stella, Boulogne and Professor Domenico Palombo, Genoa, presented their personal experience in endovascular treatment by various techniques, including subintimal angioplasty, and Sir Peter Bell intervened to defend the role of Bolia’s technique in terms of patency and healing of lesions.

Professor Francesco Spinelli presented his 20-year experience in non-invasive evaluation of patients before treatment, focusing some technical changes induced by the advent of endovascular therapy.

The final session was devoted to the important role of medical treatment in the most challenging patients with critical limb ischemia.

Many thanks to Dr Domenico Baccellieri, University Hospital Messina.