Scientific Program

Conference Series Ltd invites all the participants across the globe to attend World Congress On Vascular Diseases, Medicine & Surgeons Summit Chicago, Illinois, USA.

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Day 1 :

  • Vascular Physiology and Pathology

Session Introduction

Gavin Robert Norton

School of Physiology, University of the Witwatersrand Medical School, Johannesburg SOUTH AFRICA

Title: Aortic Reflected Waves: The Importance of Wave Separation Analysis in Cardiovascular Risk Prediction.
Speaker
Biography:

Gavin Robert Norton (MD, PhD) is an ad Hominem Full Professor in School of Physiology and the Founder and Co-Director of the Cardiovascular Pathophysiology and Genomics Research Unit at the University of the Witwatersrand (WITS). Professor Norton has over 150 original publications, predominantly in leading international cardiovascular journals, which have emanated in at least 11 editorial commentaries and a total of 3586 citations to-date. Hence he has an h index of 35. Professor Norton completed his MD in 1987 and PhD in 1993 at WITS, a fellowship at University of Masachusetts in 1997, and was recipient of the prestigious Vice-Chancellor’s Research Award at WITS in 1998.

Abstract:

Although pulse pressure (PP) is a well-recognised predictor of cardiovascular outcomes beyond steady-state pressures, aortic PP may be markedly lower than brachial PP. There is increasing evidence that aortic PP associates with cardiovascular damage independent of brachial PP, but an explanation for this finding is a topic of continuous debate. Although aortic reflected (backward) waves contribute numerically less than forward (incident) waves to aortic PP, there is increasing evidence that backward waves largely determine the brachial BP-independent relations between aortic PP and cardiovascular damage. Furthermore, the impact of backward waves on aortic PP and cardiovascular end-organ changes cannot be accurately determined by augmented pressures (or augmentation index) obtained from simple pulse wave analysis. Rather current evidence suggests that aortic backward wave amplitudes should be acquired from wave separation analysis in order to accurately identify the impact of backward waves on aortic PP and cardiovascular end-organ changes. In this regard, large cross-sectional studies, outcome-based studies and intervention studies all point to a need for wave separation analysis as being superior to simple pulse wave analysis (augmented pressures or augmentation index) when identifying the impact of backward waves and the timing of the forward wave on aortic PP and end-organ changes. Although wave separation analysis is ideally derived from simultaneous aortic pressures and velocity measurements, simple, quick, easy to use, and valid non-invasive approaches to obtaining backward wave pressures are presently available for clinical use. This opens the possibilities of risk predicting and modifying antihypertensive therapy based on backward wave pressures.

Kapil Pant

CFD Research Corporation, Huntsville, AL 35806, USA

Title: Microvascular Systems on a Chip
Speaker
Biography:

Kapil Pant holds a Ph.D. in engineering with expertise in particulate systems, fluid mechanics, and biological transport. Over the past 15 years, he has led the development of conventional and micro biomedical and environmental technologies, micro- and nano- fluidic sample preparation and detection systems, and advanced computational models for cell and particulate systems. He is the Vice President of Biomedical & Energy at CFD Research Corporation, a small high tech business, and the Chief Operating Officer (COO) of SynVivo, LLC , a leading provider of advanced cell-based assays.

Abstract:

Cellular and molecular interactions are critical to many physiological, pathological and pharmacological processes in the microvasculature. For instance, they play an important role in determining the delivery performance of therapeutics transport in vivo. Static well plate assays and in vitro fluidic devices have been instrumental in our understanding of the biological interactions in. However, widely used flow chambers suffer from several limitations for studying the in vivo microvascular environment. These include (a) lack of critical morphological features (e.g., bifurcations, tortuosity), (b) inability to distinguish between healthy vs. diseased vasculature, (c) large consumable volumes, and (d) inability to support co-cultures. To overcome these limitations, we have developed SynVivo (derived from ‘synthetic in vivo’) microfluidic assays for studying cell-cell and cell-drug studies in an in vivo like environment. The SynVivo devices are based on idealized and in vivo derived microvascular networks patterned onto a plastic, disposable substrate to mimic the morphological and physiological conditions observed in vivo. The devices can be functionalized using a variety of cells (e.g., endothelial, tissue, tumor) and combine two critical elements characteristic of the in vivo microvacular milieu: (a) 3D multi-cellular cultures to capture the realism, and (b) fluid shear and mechanical strain to capture the dynamics, thereby affording high-fidelity simulation of cell, tissue or organ physiology. Sample results from case studies on drug particle adhesion, drug transport, particle shape effects, gene delivery, cell migration and toxicity will be presented. Future applications of the platform will be discussed.

  • Vascular Diseases
Biography:

The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan 2nd Road, Guangzhou, 510080. 2Interdepartmental Program in Vascular Biology and Therapeutics

Abstract:

Adipocyte dysfunction is highly correlated with the development of diabetes. Protein SUMOylation has emerged as important regulatory mechanisms for protein function. In this study, we show that mice with a genetic deletion of the SUMO-specific protease SENP1 gene in adipocytes (SENP1-apKO) develop a type 1 diabetes mellitus (T1DM), including hyperglycemia, glucose intolerance, and increased circulating diabetic markers insulin autoantibody, C-reactive protein and beta-hydroxybutyrate with normal lipid profiles. The pancreases of SENP1-apKO mice exhibit increased infiltration of T cells and inflammation-induced β-cell apoptosis. Detailed analyses indicate that proinflammatory cytokines produced by pancreatic adipocytes in SENP1-apKO mice precedes the onset of T1DM phenotype. Mechanistic studies show that NEMO, the NF-κB essential molecule, is a major target of SENP1 in the adipose tissues. SENP1 deletion in pancreatic adipocytes enhances NEMO SUMOylation at lysine 277/309, augmenting NF-κB activity, cytokine production and pancreatic inflammation. More importantly, NF-κB inhibitor could inhibit pre-diabetic cytokine production, beta cell damages and T1DM phenotype in SENP1-apKO mice. Our study has uncovered a novel mechanism for the onset and progression of T1DM associated with adipocyte dysfunction. We will also report the cardiovascular disease phenotype in SENP1-apKO mice and discuss potential mechanisms.

Tianhua Zhang

Department of vascular surgery, The Second Affiliated Hospital of Harbin Medical University

Title: Effects of argatroban on patients with lower extremity deep vein thrombosis
Biography:

Tianhua Zhang has completed his PhD at the age of 28 years from Harbin Medical University. He is the associate chief doctor of vascular surgery. He has published more than 15 papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

The primary treatment of deep vein thrombosis (DVT) is systemic anticoagulation, which reduces the risk of propagation of thrombus, pulmonary embolism (PE) and the recurrence of venous thrombosis. Argatroban is a synthetic direct thrombin inhibitor that does not require antithrombin to provide effective anticoagulation. In the present study, we examined the effects of argatroban on patients with lower extremity DVT and evaluated the efficacy and safety of argatroban therapy in DVT patients. We considered 189 consecutive DVT patients documented by clinical scores and duplex ultrasonography, who were randomly divided into the following three groups: 63 patients were given subcutaneous injection of low-molecular-weight heparin (LMWH) (group A), 63 patients were given continuous intravenous argatroban (group B) and 63 patients were given LMWH and argatroban (group C).  Statistically significant differences in circumference at the calf and thigh levels were found in group A and C or group B and C on day 14 (p<0.05). When comparing day 0 and day 14, significant differences were determined in each group for the differences in circumference of the two legs at the thigh and calf levels (p<0.01 or p<0.001 ). Study on degree of thrombus regression showed the advantage of group C over group A or group B by chi-squared test. Argatroban have demonstrated promise of greater efficacy with less bleeding risk in DVT treatment. We suggest that anticoagulation with argatroban is a useful option in patients with DVT alone or combined with LMWH.

Subroto Chatterjee

Director Sphingolipid Signaling laboratory Johns Hopkins University

Title: Prevention and Interference of Atherosclerotic Heart Disease-New Insights and Directions
Biography:

Dr. Subroto Chatterjee (Ph.D.Biochemistry) is a full Professor in the Departments of Medicine and Pediatrics-Cardiology Division at the Johns Hopkins University, School of Medicine. And serves as the Director of a Sphingolipid Signaling laboratory. Dr. Chatterjee earned his undergraduate training in Chemistry in India and post graduate training at the University of Toronto, Canada. Followed by a post doctoral fellowship in the esteemed laboratory of Dr. Charles. C. Sweeley in Michigan ,USA. He joined the faculty at the Johns Hopkins University and rose to the rank of Professor. He also served as the Director of the Atherosclerosis and Vascular Biology program in Singapore for Johns Hopkins Singapore. Dr. Chatterjee has published over 150 papers, book chapters, review articles commentaries in peer reviewed journals and has been awarded numerous world –wide patents for his discoveries. And serves in the Science advisory board and thought leader for Bioctech/Pharma companies. He has received international and national awards for his contributions to Science such as the American Heart Association “Allstar” award, “Ranbaxy International award” for Medical research from the President of India, United nations award for dessiminating new knowledge and advising young scientists in developing countries, Mizutani award, Japan. Outstanding scientist, Gov Paris Glendenning

Abstract:

We have previously observed that the levels of blood cholesterol and sugar containing lipids called glycosphingolipids (GSL) rise and fall in tandem upon plasma exchange therapy in patients homozygous for familial hypercholesterolemia(FH). Moreover, cultured skin fibroblasts from LDL receptor negative FH subjects were unable to metabolize GSL/Lactosylceramide-associated with LDL efficiently compared to normal fibroblasts having functional LDL receptors. Such findings rationalized our approach to inhibit GSL synthesis as a novel approach to mitigate atherosclerotic heart disease. In a series of experiments, recently described in the journal Circulation, we have identified and halted the action of GSL and cholesterol. Using an inhibitor of GSL synthesis we could block abnormal cholesterol production, transport , breakdown and improve bile acid production successfully thus preventing and interfering atherosclerotic heart disease in a poE-/- mice and normal rabbits fed a western diet, rich in cholesterol and triglycerides. In particular, the blood levels of oxidized LDL, LDL cholesterol, and triglycerides were decreased and the level of HDL cholesterol was increased. Treatment markedly decreased arterial calcification, and vascular wall stiffness Recently, we have remarkably improved on the efficacy of the GSL inhibitor to prevent and interefere with atherosclerotic heart disease by way of encapsulating it within a biodegradable polymer which allows rapid absorption in the gut and slow release of drug over a period of days instead of hours. Thus inhibition of GSL synthesis is useful to ameliorate atherosclerotic heart disease and GSL synthesis inhibition an alternative to the use of family of statins and PCSK-9 antibody.

Angela Jill Woodiwiss

School of Physiology, University of the Witwatersrand Medical School, Johannesburg SOUTH AFRICA.

Title: Indices of Aortic Function: Should Pulse Wave Velocity be the Only Index of Aortic Function Used to Predict Risk?
Speaker
Biography:

Angela Jill Woodiwiss is an ad Hominem Full Professor in the School of Physiology and Co-Director of the Cardiovascular Pathophysiology and Genomics Research Unit at the University of the Witwatersrand. Professor Woodiwiss has over 150 original publications, 68% of which are in leading international journals in the cardiovascular field. Her publications have emanated in a total of 3547 citations and she has an h index of 35. Eleven of her publications have generated editorial commentaries in prestigious cardiovascular journals. Professor Woodiwiss completed her PhD (Cardiovascular Physiology) in 1995 at University of the Witwatersrand and a postdoctoral fellowship at University of Masachusetts in 1997.

 

Abstract:

Aortic pulse wave velocity (PWV) is the current gold standard noninvasive measurement of arterial stiffness. However, data identifying the possible mechanisms which may explain the relationship between PWV and cardiovascular outcomes are limited. In this regard aortic PWV may index the impact of chronic inflammation on the cardiovascular system. Indeed, we have shown that galectin-3, a profibrotic inflammatory substance, and the adipokine resistin, but not alternative adipokines, are associated with PWV independent of blood pressure (BP), insulin resistance and general inflammation. However, we have also demonstrated that inflammatory changes may not account for aging effects, as indexed by telomere length, on aortic PWV and hence alternative biological effects require elucidation. Moreover, the value of PWV may be limited in some circumstances. Indeed, in advanced peripheral vascular disease PWV may be markedly reduced. In this regard, several alternative indexes of aortic function may nevertheless be of value in risk predicting and these effects may not be explained by an impact of PWV. Indeed, central aortic pulse pressure (PP) and aortic-to-brachial PP amplification (PPamp), which may be determined by an increased salt intake and alternative effects on aortic backward wave function, have been associated with cardiovascular end-organ changes and outcomes beyond brachial BP, and these changes may not be attributed to increases in PWV. As aortic PP and PPamp may be imputed from simple clinical measures, and imputed PPamp is associated with end-organ changes and all-cause mortality beyond brachial BP, PPamp may be an important cost-effective method of risk predicting beyond aortic PWV.

 

Speaker
Biography:

Guillermo Vilalta-Alonso obtained the Degree of Mechanical Engineering from Instituto Superior Politecnico Jose A. Echeverria/Havana, Master and Dr. in Mechanical Engineering from the University of Sao Paulo/ Brazil. Currently is associated professor at Thermal Sciences and Fluid Department of the Federal University of São João del-Rei/Brazil. His research interests include numerical simulation, fluid mechanics, turbomachinery and biomechanics. Member of the European Society of Biomechanics.

Abstract:

Abdominal aortic aneurysms (AAAs) rupture is one of the main causes of death in the world. Nowadays, there is consensus that current criteria to assess the aneurysm rupture risk (maximum transverse diameter and growth rate) cannot be considered as reliable indicators. Hence, the clinical management of aneurysmatic patients faces the challenge of identifying if other indices could be used as rupture predictors. Recently, rupture predictor indices have been proposed among they asymmetry, effect of intraluminal thrombus, wall stiffness and thickness saccular index, mechanical stress. Some of these indices have been more successful than others due to the difficulty for extracting in-vivo and non-invasive information, difficulting its implementation in daily clinical management. To overcome this limitation and considering the influence of the AAA morphology on aneurysm rupture potential, some size and shape geometric indices, based on lumen centerline, have been proposed and have been correlated with the hemodynamic stresses, as an indicator of the rupture risk. The main advantage of the geometric indices is that they can be determined, in easy way, from computed tomography. The objective of this study is to discuss the basics of this approach and how it can help to gain physical insight based on quantitative results. The results up to now obtained show that statistical techniques could be an appropriate method to determine potential correlations and that other indices like, asymmetry, deformation rate, AAA length, saccular index, are important and could also be readily incorporated into surgeon’s decision making.

  • Trauma Induced Vascular Disorders

Session Introduction

Amy Leung

Mater Health Services, South Brisbane, Queensland, Australia

Title: The Incidence of Peripheral Catheter-Related Thrombosis in Surgical Patients
Biography:

Amy Leung completed her undergraduate medical degree at James Cook University in 2014. She has had several publications in the area of thrombosis. She is now currently working at the Mater Health Services in Brisbane.

Abstract:

Central venous catheters and peripherally inserted central catheters are well established risk factors for upper limb deep vein thrombosis. There is limited literature on the thrombosis rates in patients with peripheral catheters. A prospective observational study was conducted to determine the incidence of peripheral catheter-related thrombosis in surgical patients. Methods. Patients deemed high risk for venous thrombosis with a peripheral catheter were considered eligible for the study. An ultrasound was performed on enrolment into the study and at discharge from hospital. Participants were reviewed twice a day for clinical features of upper limb deep vein thrombosis during their admission and followed up at 30 days. Results. 54 patients were included in the study. The incidence of deep vein thrombosis and superficial venous thrombosis was 1.8% and 9.2%, respectively. All cases of venous thrombosis were asymptomatic. Risk factor analysis was limited by the low incidence of thrombosis. Conclusion. This study revealed a low incidence of deep vein thrombosis in surgical patients with peripheral catheters (1.8%). The study was underpowered; therefore the association between peripheral catheters and thrombosis is unable to be established. Future studies with larger sample sizes are required to determine the association between peripheral catheters and thrombosis.

  • Non Pharmacological Approach to Vascular Diseases
  • Pharmacotherapeutic approach to Vascular Diseases
  • Clinical and Translational Vascular Medicine

Session Introduction

Rica Tanaka

Department of Plastic and Reconstructive Surgery, Tokyo, Japan

Title: Simple and effective vascular and tissue regenerative cell therapy for non-healing wound patients.
Speaker
Biography:

Rica Tanaka MD.,PhD is associate professor and a director of the lab of Juntendo University of School of Medicine, Department of Plastic and Reconstructive Surgery from year 2011. She is specialized in plastic surgery, wound healing, diabetic foot therapy, vascular medicine, and stem cell medicine and also is the board memeber of Japanese Society of Plastic Surgery, Japanese Society of Regenerative Medicine, Japanese Wound Healing Society, Japanese Society of Foot care and more. She has published more than 50 papers in reputed journals and has been serving as an editorial board member of repute.

Abstract:

 

The quality and quantity of endothelial progenitor cells (EPC) is known to be impaired in various diseases, thereby raising declined tissue repair in autologous EPC therapy. We have recently disclosed a newly developed serum free ex vivo expansion system called Quantity and Quality Control Culture System (QQc) using peripheral blood mononuclear cells (PbMNC) to potentiate the vasculogenic property of diabetic EPCs for enhanced vasculogenesis and tissue repair from small amount of blood. QQc system of autologous peripheral blood MNC (MNC-QQc) can expand EPCs to 10 times and the vasculogenic function of MNCs up to 40 times compared to non-culutred MNCs in diabetic patients. Our new technology will provide the methodological clue to overcome the insufficient efficacy of naïve mononuclear cell therapy for diabetic non- healing wounds. From our data, 150cc of peripheral blood will be necessary to replace the existing EPC therapy. With this new technology, we will be able to establish outpatient based simple, safe and effective vascular and regenerative therapy for diabetic patients. We have validated the safety and efficacy of human MNC-QQc cell therapy for non-healing wounds prior to clinical trial overcoming the new regenerative therapy law recently passed in Japan. With approval from the government, we have now started the clinical trial. Under the new law, stem cell therapy approval for government reimbursement will be conducted rapidly. Our goal is to deliver an outpatient based simple, safe and effective vascular and regenerative therapy for patients with non-healing wounds by year 2020.

kwon-Soo Ha

Kangwon National University School of Medicine, Gangwon-do 200-701, Korea

Title: Molecular mechanism and prevention of VEGF-induced microvascular leakage in the retina of diabetic mice
Speaker
Biography:

Kwon-Soo Ha has completed his PhD in 1991 from the University of Texas at Austin and postdoctoral studies from Vanderbilt University School of Medicine. He is the director of the Institute of of Medical Science, Kangwon National University School of Medicine, Korea. He is also the principal investigator of Vascular Network Convergence Research Lab Program supported by the Korea Research Foundation. He has published 185 papers in peer reviewed international journals. His research interests are prevention of diabetic complications including retinopathy, cardiovascular diseases, and impaired wound healing and applications of protein arrays to serodiagnosis.
 

Abstract:

Diabetic retinopathy is predominantly caused by vascular endothelial growth factor (VEGF)-induced microvascular leakage; however, the underlying mechanism is unclear. Here, we demonstrated that hyperglycemia induced microvascular leakage by activating TGase2 and this vascular leakage was inhibited by C-peptide in diabetic retina. VEGF elevated TGase2 activity through sequential elevation of intracellular Ca2+ and reactive oxygen species (ROS) levels in endothelial cells. The TGase inhibitors cystamine and monodancylcadaverin or TGase2 siRNA prevented VEGF-induced stress fiber formation and vascular endothelial (VE)-cadherin disruption, which play a critical role in modulating endothelial permeability. C-peptide inhibited the VEGF-induced ROS generation, stress fiber formation, and disassembly of vascular endothelial cadherin in endothelial cells. Intravitreal injection of C-peptide, two TGase inhibitors, or TGase2 siRNA successfully inhibited hyperglycemia-induced TGase activation and microvascular leakage in the retinas of diabetic mice. Thus, our findings suggest that C-peptide prevents VEGF-induced microvascular permeability by inhibiting ROS-mediated activation of TG2 in diabetic mice.

  • Endovascular Intervention

Session Introduction

Essam Aboelnazar

1-General Surgery. 2-Gastrointestinal Surgery with Laparoscopic experience. 3-Hepatobiliary Pancreatic Surgery. 4-Breast Surgery. 5-Thyroid Surgery. 6-Trauma and Emergency Unit (Military Causalities ). 7- Thoracic Surgery.

Title: Prevalence of Venous Thrombo-Embolism & Related Morbidity and Mortality among Hospitalized Patients in Saudi Arabia (SAVTE Study)
Speaker
Biography:

Venous Thrombo Embolism (VTE) is a serious and potentially fatal condition. Despite of its cost-effectiveness and favorable outcome evidence-based prophylaxis is underutilized in many countries including Saudi Arabia. VTE prevalence and incidence has not been clearly defined on a large scale bases in Saudi Arabia.

Abstract:

This study is a retrospective observational study that was conducted in 7 major hospitals in Kingdom of Saudi Arabia. The primary objectives were to estimate the percentage of patients who received prophylactic thrombolytic treatment according to ACCP guidelines among VTE-patients in addition to, assess the mortality rate in them. The Secondary objectives were: to assess the percentage of VTE confirmed patients in each ward type (surgical and medical), to estimate the percentage of patients prescribed anti-coagulant therapy and adhering to it and to determine percentage of VTE mortality among all cause hospital mortality.

1241 of confirmed VTE were included in the study analysis. 58.3% of them were DVT only, 21.7% were PE and 20% were both DVT and PE.21.4% and 78.6% of confirmed VTE occur in surgical and medical patients respectively. 40.9% of VTE cases received appropriate prophylaxis.

Only 63.2% of surgical patients and 34.8% of medical patients received this prophylaxis (P < 0.001). Mortality rate was 14.3% of all patients representing 1.6% of total hospital mortality. Mortality was 13.5% for surgical patients Vs 14.5% for medical patients (P > 0.05). 89.4% of survived patients received anti-coagulation therapy at discharge and 71.7% of them were adherent to it on follow-up.

Eliseo Candela Beltran

Hospital de Manises, 46940 Manises, Valencia, SPAIN

Title: Endovascular aneuryms repair.
Speaker
Biography:

Eliseo Candela Beltrán  has completed his Medicine degree at the age of 24 years at Rovira i Virgili University, Tarragona, Spain and completed Angiology and Vascular Surgery speciality in Hospital  la Fe. Valencia, Spain.

He completed an observership in Vascular Surgery department at Barne´s and Jewish Hospital, Saint Louis, MO, USA in 2015.

He is currently Vascular Surgery consultant at Hospital de Manises, Valencia, Spain.     
 

Abstract:

An arterial aneurysm is a permanent and localized dilation of an artery having at least a 50% increase diameter compared to expected normal artery diameter.

The aneurysms  are one of the most common vascular diseases causing disability and death. Aneurysms are common in elderly people and can occur in most arteries throughout the body.

The most common aneurysm is the abdominal aortic aneurysm(AAA).

AAA  is ranked as the 13th leading cause of the in the United States.

The overall mortality rate of ruptured AAA is as high as 80% to 90%. Due to that mortality of ruptured aneuryms is recommended to perform  an elective repair when the aneurym  reaches  a critical diameter before rupture.

The objective in the treatment is to achieve the complete exclusion of blood flow inside the aneurym, we can get that exclusion using endovascular therapies such as stenting, endografting or  complete embolization of the aneurysm.

For more than 50 years open surgical treatment was the gold standar practice, whereas endovascular aneurysm repair (EVAR) was first reported in 1986.

EVAR has increasingly become preferred to open  repair (OR) as the primary option for managing aneurysms in morphologically suitable patients due to its lower rate of morbidity and mortality compared with OR.

Over the last decade with the endovascular revolution, there have been significant developments in the endovascular therapies and  more recently the branched devices  are emerging will increase the perspectives  of endovascular treatment for aneurismal pathology in multiple arterial sectors.

 

 

Mohammad Arabi

M.D. FRCR, DABR, ABNM Consultant Interventional Radiologist Vascular Interventional Radiology Medical Imaging Department King Abdulaziz Medical City National Guard Health Affairs

Title: Sharp central venous recanalization in hemodialysis patients: A single institution experience
Biography:

Technical success was achieved in all cases. SVC recanalization achieved symptoms’ relief and restored fistula function in the symptomatic patient. One patient underwent arterio-venous fistula creation on the recanalized side 3 months after the procedure. The remaining catheters were functional at median follow up time of 9 months (1-14 months). Two major complications occurred including a right hemothorax and a small hemopericardium, which were managed by covered stent placement across the perforated SVC

Abstract:

Materials and Methods: Since January 2014, a series of 7 consecutive patients (4 male, 3 female), mean age 35 years (18-65 years), underwent sharp central venous recanalization. Indications included obtaining hemodialysis access (n=6) and restoration of superior vena cava (SVC) patency to alleviate occlusion symptoms and restore fistula function (n=1). The trans septal needle was used for sharp recanalization in six patients, while it could not be introduced in one patient due to total occlusion of the inferior vena cava (IVC). Instead, trans mediastinal SVC access using Chiba needle was obtained.

Nedaa Skeik

Associate Professor of Medicine Section Head, Vascular Medicine Medical Director, Thrombophilia & Anticoagulation Clinic Medical Director, Hyperbaric Medicine Medical Director, Vascular Laboratories

Title: The New Era of Anticoagulation
Biography:

Nedaa Skeik has completed his MD from Istabul University, Internal Medicine residencey at New York Medical College, and Vascular Medicine fellowship at Mayo Clinic, Rochester MN. He has published more than 40 peer-review papers in reputed journals and has been serving as an editorial board member of Annals of Vascular surgery. His other positions are as below.

Abstract:

Despite starting as a rat poison, warfarin has done a good job in reducing thromboembolic events in in patients with atrial fibrilations, deep vein thrombosis, pulmonary embolism and mechanical heart valves. However, wafrain has multiple pitfalls affecting the initiation and adherence rate to this medication.  Such pitfalls include requirment for bridging agents since it takes few days to reach therapeutic level in plasma, requirement for monitoring, frequent interactions with other medications and interpatient variabililty in regard to dosing. The introduction of target specific anticoagulants (DOACs) to the market has created a paradigm shift in the management of patients with non-valvular atrial fibrillation and venous thromboembolism. Based on he current data, DOACs have shown good efficacy and safety profile in compare to warfarin. However, lack of specific antidote and not being available for patients with mechanical valve creats limits their use to some extent.