VEITH symposium is one of the most authoritative, large-scale and long-standing academic events in vascular surgery in the world. Thousands of top experts from vascular surgery, interventional radiology, interventional cardiac surgery, and other vascular surgery fields from around the world attend the VEITH symposium conference each year. Here brings together various research data updates from the world, very pioneering, prospective and controversial topic discussion, clinical technology sharing with great application value, the latest and cutting-edge medical devices and technology exploration, face-to-face communication opportunities for world-class authoritative vascular surgery experts, and so on.
The 50th Annual Symposium on Vascular and Endovascular Issues (VEITH 2023) was held at the Hilton Hotel, New York Center, USA on November 14-18, 2023. Our colleagues in vascular surgery actively attended the meeting and brought wonderful speeches. Here, we have also sorted out the ideas and opinions of domestic experts on some hot topics in the conference, and welcome you to read them.
Valiant Captivia 'Optimized Seal' Advantages in TEVAR
SHU Chang
Fuwai Hospital CAMS & PUMC
Clinically, the anatomical morphology of the aortic arch is ever-changing and is the root cause of great challenges faced in endovascular repair of the aortic arch (TEVAR), and poor sealing of the aortic arch increases the risk of TEVAR surgical failure. If there is inadequate stent sealing during the operation, it can lead to complications including type IA endoleak, beak phenomenon and other complications requiring reintervention. Therefore, how to adapt to different types of aortic arch from anatomical morphology and hydrodynamics is an urgent problem to be solved by stent manufacturers. Because of its unique design features, the Valiant Captivia Stent offers the advantage of "optimized sealing" in TEVAR:
1、Its unique 8-peak mechanical design, compared with other stents with only 4/6 peaks, has great advantages in apposition to the proximal aortic arch artery wall and can effectively avoid endoleak and beak.
2、Postrelease technology is important for precise positioning. Because the anatomical structure of aortic arch is various, it is very easy to produce position deviation when the stent is released before taking the stent, and further adjustment of alignment is required subsequently, which not only affects the release accuracy, but also increases the risk of complications. Posterior release technology facilitates precise positioning and release, with better stent apposition to the aorta.
3、The aortic arch has high blood flow velocity, high blood pressure, and the stent is prone to displacement. Valiant Captivia is made of a highly flexible nitinol with a proximal support ring that provides active radial support while maintaining close apposition to the aortic wall, ensuring durable anchoring and sealing, which results in excellent stability and apposition. After the stent is released, there are no worries. In some specific cases there remains a high risk of stent related complications such as endoleak and migration due to the complex anatomy of the aortic arch. Medtronic has a product, Heli-FX EndoAnchor, which is a new solution to this problem, and Heli-FX can strengthen the seal between the stent and the autologous artery and prevent and treat complications associated with poor seal. At the same time, we hope this product can be introduced into China as soon as possible and benefit more Chinese patients.
The 10-year results of the ENGAGE study strongly support EVAR durable efficacy
Chen Zhong
Beijing Anzhen Hospital, Capital Medical University
Expectations for abdominal aortic aneurysm (AAA) treatment are increasing as technology advances and the population ages. At present, endovascular abdominal aortic aneurysm repair (EVAR) has become an important treatment for AAA. The ENGAGE study is the largest EVAR registry in the world and includes 1,263 real-world AAA patients registered in 79 centers from 30 countries worldwide, with convincing 5-year, 8-year, and 10-year long-term follow-up data, which is sufficient to reflect Medtronic 's responsibility and self-confidence in Endurant products. The ENGAGE study 10-year follow-up data showed freedom from aneurysm-related mortality was 94.7% ± 1.3%, freedom from aneurysm-related reintervention was 70.3% ± 2.6%, and sac retraction was 64.1%. The efficacy, safety and superiority of the Endurant stent were well documented. There is no doubt that the ENGAGE study provides strong evidence for the long-term efficacy of EVAR in the treatment of AAA and also has some inspiration for the clinical study design in China. Our domestic clinical trials, data and products also need such a persistent spirit, hoping that there will be larger, longer and better follow-up results in the future, Chinese data will be obtained, and Chinese voices will be emitted on the international stage.
On the other hand, the management of AAA patients is also very important and includes whole-process management for disease prevention, diagnosis, treatment, and follow-up. In China, many patients have insufficient awareness of presentation, are severely ill at presentation, and it is often difficult to achieve effective and active follow-up after treatment. At present, clinicians should pay attention to disease screening so that more patients can be detected and treated early. Moreover, it is also necessary to strengthen the management of subsequent patients, including regular follow-up, the development of all-round postoperative drug treatment management, and the correction of living habits. This requires not only the efforts of clinicians, public attention and patient cooperation, but also the attention of hospital management, such as administrative authorities to strengthen patient management, establish patient databases, and develop a nationally unified, scientific, and standardized follow-up mechanism. We hope that in the future, we can work together to do a good job in the management of Chinese patients and promote the progress of disease diagnosis and treatment in China.
IN.PACT DCB No fear of challenging complex lower extremity arterial disease
Fu Guowei
Zhongshan Hospital, Fudan University
In China, patients present with insufficient awareness and poor compliance, and are often found to have reached a late course of the disease with a high degree of lesion complexity. Therefore, lower extremity arterial disease is characterized by long segments, heavy thrombus burden, and high proportion of CTO and calcification. At this year's VEITH conference, the 5-year results of IN.PACT DCB application in complex lower extremity arterial diseases presented by Professor Gunnar Tepe fully confirmed that IN.PACT DCB is safe and effective in the treatment of complex lesions in the long term, while meaning that IN.PACT DCB has a quite wide application prospect in the field of diagnosis and treatment of lower extremity arterial diseases in China. Moreover, the long-term follow-up results of the IN.PACT Global trial showed that IN.PACT DCB could effectively prevent or reduce intimal hyperplasia, maintain lumen patency, and play a good role in ISR lesions.
At the end of 2018, a meta-analysis published by Professor Katsanos showed that paclitaxel devices increased the risk of all-cause mortality at 2 and 5 years after surgery. However, an expert team consisting of Professor William A Gray, Professor Sahil Parikh, and Professor Peter Schneider, published an article in THE LANCET on October 24, 2023, strongly elucidating the safety of the paclitaxel device with huge data sizes, very high follow-up rate data, and patient-level meta-analysis data. In July, the FDA lifted the danger signs associated with increased mortality with paclitaxel-loaded devices. This means that DCB will return to a large number of clinical applications, IN.PACT DCB will be increasingly used in clinical practice in China, and the treatment efficiency and limb salvage rate of patients with lower limb arterial diseases in China will also be greatly improved.
The world 's first head-to-head randomized controlled ADVANCE trial to advance evidence of sac retraction and improve patient outcomes following EVAR
Xin Shijie
The First Hospital of China Medical University
Abdominal aortic aneurysm (AAA) is one of the most landmark diseases in peripheral vascular surgery and a high-risk vascular disease in clinical practice. With the progression of AAA disease and the diameter repeatedly increases by more than a certain range, it is possible to rupture at any time, leading to massive hemorrhage and death of patients. Therefore, high attention should be paid in clinical practice.Prophylactic procedures such as endovascular repair (EVAR) are recommended if the aneurysm diameter reaches 5.5 cm and the risk of rupture increases.The Medtronic Endurant ™ Stent has been widely used in EVAR technology worldwide, including China, in a large number of applications.As the largest EVAR registry in the world, the ENGAGE study of the Endurant ™ stent also brings important guidance value for the treatment of complex AAA patients in the real world.This study attaches importance to and emphasizes the predictive value of "sac retraction" as an indicator for the prognosis of EVAR.Compared with further sac expansion, sac retraction means reduced intraluminal pressure, thrombolysis and good vascular remodeling of the aneurysm false lumen, as well as subsequent lesion deterioration and reduction and disappearance of the risk of rupture, and "sac retraction" becomes a new criterion used to predict the long-term outcome of EVAR.During the 10-year follow-up period of the ENGAGE study, the proportion of patients with sac retraction remained stable and remained essentially at > 64%.This data further confirms the technical maturity of EVAR and the satisfactory efficacy of Endurant ™ stent in EVAR.The recently launched ADVANCE study, the world 's first head-to-head RCT for sac retraction, was also presented at the conference, and its future results are eagerly awaited.It is worth noting that there are various classifications of aneurysms according to pathology and histology, and it is hoped that the prediction effect of sac retraction can be refined for different types of aneurysms in the future, and the sac retraction status and degree of different aneurysms can be further explored, which is more helpful to guide clinicians' clinical decision-making.
One-stop TAVR and TEAVR Procedure Protocol
Luo Jianfang
Guangdong Provincial People 's Hospital Vascular Disease Diagnosis and Treatment Center
In clinical practice, aortic valve disease with aortic disease is common, and about 6-10% of patients with aortic stenosis have descending aorta or abdominal aorta disease, and the treatment plan needs to be selected in combination with the specific condition of specific patients. The coexistence of the two diseases is often divided into priorities, whether to "one-stop" surgery, it is necessary to comprehensively assess the aortic and aortic valve lesions. For patients who meet the indications for "one-stop" surgery after adequate evaluation, one-stop TAVR + TEVAR surgery can not only reduce the patient's pain, but also critically improve the treatment efficacy and safety, which can bring more benefits to patients.
