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There has been major progress in the treatment of peripheral arterial disease (PAD) globally in the last few years, “but there are still issues that need to be addressed”, Marianne Brodmann (Medical University of Graz, Graz, Austria) told Interventional News, reviewing her experience as co-director of the recent BD PAD Summit (20–21 June, Riga, Latvia). She said the event highlighted the “consensus and strong will” among physicians to “improve” the picture when it comes to fighting the disease.
The summit was led by course chair Bruno Migliara (Pederzoli Hospital, Pescheria del Garda, Italy), alongside co-directors Brodmann, Koen Deloose (AZ Sint-Blasius Hospital, Dendermonde, Belgium), and Marco Manzi (Policlinico Abano Terme, Abano Terme, Italy).
Aimed at “shaping the future of PAD patient care”, its programme was divided into five sections. Sessions on diagnostic tools and algorithms were complemented by presentations on access and crossing lesions, treating lesions and optimising patency, and finally, on the future of PAD treatment. Across a day and a half, over 170 attendees were offered 24 hours of hands-on sessions, as well as the opportunity to hear 31 presentations by 20 key opinion leaders in the field. Rapid-fire debates followed most presentations, while a research and development session offered education on further new advances.
Brodmann opened the conference by addressing what she called the historical underappreciation of the problem of PAD—236 million adults worldwide have the condition—when compared with other conditions such as coronary artery disease and stroke.
More recently, she said, there has been “increasing recognition that PAD is an important cause of cardiovascular morbidity and mortality”, with particular attention given to its status as a “leading cause of physical disability”, especially when it progresses to critical limb ischaemia (CLI).
The problem is growing, she suggested, noting a study which found that the prevalence of the disease jumped by 45% globally between 2000 and 2015. “It can only be changed by awareness campaigns […] from healthcare providers as well as the general population,” she told Interventional News.
Part of the issue, Brodmann suggested, lies with difficulties in diagnosing PAD. This set the stage for the beginning of the first session on diagnostic tools, where Christos Rammos (University of Duisburg- Essen, Essen, Germany) highlighted a selection of new options in angiography, among them carbon dioxide angiography. Following him came Daniel van den Heuvel (St Antonius Hospital, Nieuwegein, The Netherlands), who assessed duplex ultrasound as a method for developing an “objective endpoint” in the definition of optimal results from revascularisation procedures.
Algorithms came to the forefront next, with Brodmann stepping in to deliver the absent Maria Ruffino’s (Institute of Imaging of Southern Switzerland, Lugano, Switzerland) presentation on the need for clarity on the best aortoiliac lesion treatment. A compelling discussion followed, where it was suggested by one audience member that lack of evidence-based treatment in this area could be due to physicians’ preference. In conversation with Interventional News, Brodmann said: “This is indeed the case. Therefore, there is a need for creating strong treatment algorithms in different areas.” This, she suggested, was a need that could be met by physicians.
Deloose, meanwhile, also contributed to the session by telling the audience to base their treatment algorithms on their prepping algorithms—which should in turn be based on how you pass the lesion. PAD below the knee (BTK) was addressed during this session by Marc Sirvent (General University Hospital of Granollers, Granollers, Spain), who, in an assessment of different strategies, highlighted the “essential” nature of good angioplasty technique.
Next up came a set of talks on access and crossing lesions. Ralf Langhoff (Sankt Gertrauden Hospital, Berlin, Germany) set the tone by alerting listeners to the fact that up to 11% of peripheral vascular interventions result in access complications, underscoring the importance of addressing them. Also speaking in this session was Giacomo Isernia (Azienda Ospedaliera di Perugia, Perugia, Italy), who outlined why the guidewire is “essential” in complex occlusion cases. Yann Gouëffic (University Hospital of Nantes, Nantes, France) addressed the audience too, stating on the subject of vessel preparation devices that “no studies have shown” that they offer a decisive advantage in cutting intimal hyperplasia.
Following one packed day of presentations came another, with the session on lesion treatment opening with further discussion from Rammos, who presented on a rotational atherothrombectomy device. In the subsequent talks on lesions, Mercedes Guerra (University Guadalajara Hospital, Guadalajara, Spain) gave a strong presentation on the need for better classification of extremely calcified lesions, which she said require their own treatment approach.
Migliara spoke to Interventional News following the summit to praise Guerra’s talk, which he said “analysed very well and deeply one of the most challenging and discussed questions: how to treat calcium”. The presentation and discussion which followed illuminated the need to “better define the best treatment choice for every different type of lesion”, he added.
Migliara himself presented during this session, returning to the rotational atherothrombectomy device explored by Rammos, which he said held particular promise for the treatment of in-stent restenosis. Its advantage, he averred to Interventional News, was that it “allow[s] retreatments without increasing their complexity”. In the debate following his talk, he suggested its repeated use for debulking poses fewer risks than bypass.
One highlight of the conference was what Migliara described as its “best debate”, between Deloose and Sherif El Kerdawy (Wadi El Neel Hospital, Cairo, Egypt) on the benefits of covered and uncovered stents in iliac artery treatment. Through this “scientific but also friendly debate”, Migliara said, “we understood better where the best choice is uncovered and where [it is] covered.” The audience swayed to the side of El Kerdawy: a post-debate poll found 42.9% on the side of the covered stent and 57.1% on the side of the uncovered.
“I learned many new ideas not only about techniques, but also about new materials and devices,” Migliara said of the concluding session on the future of PAD. Drawing special attention to vessel preparation and resorbable stents for BTK, he also praised a talk by Marta Lobato (Hospital de Cruces, Barakaldo, Spain) on new arterialisation techniques.
Migliara thanked those who spoke at the summit. Their “interesting presentations” and “active discussions” provided opportunities for learning, he said in review, and allowed him and his co-directors “to achieve the aim of this meeting”.
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