In the heart of England, practitioners with an interest in endovascular interventions, from a wide range of specialties, came together for the first Endovascular Forum UK and Ireland
The first meeting of the Endovascular Forum UK and Ireland, organised under the combined auspices of the Vascular Surgical Society of Great Britain and Ireland and the British Society of Interventional Radiology, was held in June in Stratford-upon-Avon
Peter Harris, co-chairman of the meeting with Tony Watkinson, introduced this multidisciplinary meeting, which brought together those with an interest in endovascular interventions for discussion and debate on topics dedicated to this rapidly advancing field.
Aortic aneurysm – abdominal
Aires Barros D’Sa, in opening the session on abdominal aortic aneurysm, said that there was no friction, or at least very rarely, between the specialties involved in endovascular repair in the UK. This, he went on, would give the Endovascular Forum a great deal of strength.
Andrew Bradbury looked at the implications for clinical practice of the results of the UK Small Aneurysm Trial (UK SAT). He said that trials had identified who we shouldn’t operate on but not who should be operated on. This, he argued, would be a better position, but it requires another trial. He drew parallels with drug approval processes. If the procedure was a drug would it be licensed by the FDA? No because the benefit hasn’t been proved.
After the UK SAT, it is very hard to defend operating on male aneurysms <5.5cm, although these will grow. What if the patient with a 4.5-5cm aneurysm says he doesn't want this ticking time bomb inside? However, it should be remembered that with rigorous surveillance, no surgery is not no treatment.
Thresholds are different for different groups – as the UK SAT found, women are four times more likely to rupture. Bradbury admitted he has a lower threshold for operating on women and highlighted the need more specific groupings.
Roger Greenhalgh, who presented progress of the UK EndoVascular Aneurysm Repair (EVAR) trials, speaking about the meeting said, “It has taken sometime to have this collaboration.”He reiterated that EVAR 1 recruitment remains ahead of schedule, describing this as a “great achievement”and that EVAR 2’s recruitment, although slow initially is now catching up and a significant number will be achieved by 2003 when findings are to be reviewed.
“This data is awaited all over the world. The UK is producing data that will meet the needs of Americans and the rest of Europe.”Greenhalgh continued by saying that he expects there to be “a clear result”from the trial next year. However, if endovascular is close to surgery there would be a need to continue the trials to find long-term suitability.
Aortic aneurysms – thoracic
Michael Dake, of Stanford University, USA, flew over especially for this meeting. He discussed endovascular management of dissecting aneurysms, highlighting the type of intramural haematoma to treat: Type A IMH, IMH with PAU (penetrating atherosclerotic ulcers), Type B IMH with persistent pain or increase in pleural effusion.
He concluded by saying that the spectrum of applications for endovascular stent-graft treatment continues to expand. This will be aided by the expected development of refined devices with particular foci.
Krassi Ivancev then emphasised that combined open and endovascular repair for complex aneurysms appears to offer the best of both approaches. However, there is the problem of how to communicate – between the thoracic surgeon and radiologist. Close cooperation must be encouraged.
Carotid artery disease
The next day, Peter Rothwell reviewed the European Carotid Surgery Trial (ECST), a randomised trial of carotid endarterectomy as medical treatment, and compared it with the North American NASCET trial. Despite the different methodologies, the results of the trials are virtually identical in that the show that surgery reduces risk of stroke in patients.
In concluding the meeting, Peter Harris said that it is still to be decided if this meeting will be annual or held once every two years.