Day 2 :
- 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.
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
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
Session Introduction
Wang Min
University School of Medicine
Title: Protein SUMOylation in the adipocyte modulates inflammatory responses, diabetes and cardiovascular 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?
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.
Guillermo Vilalta-Alonso
Departamento de Ciencias Termicas e dos Fluidos/UFSJ
Title: Abdominal aortic aneurysm rupture risk prediction, an open challenge for vascular surgeons
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.
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
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
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.
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)
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.
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.
- Vascular Imaging and Diagnostic Testing
Session Introduction
Sergio Brasil
University of Sao Paulo
Title: A systematic review on the usefulness of computed tomography angiography in diagnosing brain death.
Biography:
Sergio Brasil is neurosurgeon and neurosonologist. He currently is engaged in research in the field of cerebral hemodinamics and transcranial Doppler.
Abstract:
Organ transplantation depends more often of donation from brain dead (BD) individuals. Several complications make the diagnosis of BD medically challenging and a complimentary method is needed for confirmation. Additionally, in many countries around the world, the complimentary diagnosis is mandatory by law, despite there are still many areas where these methods are not available. In this context, computed tomography angiography (CTA) could represent a valuable alternative, because of its widespread presence. However, the reliability of CTA for confirming brain circulatory arrest remains unclear. Methods: A systematic review was performed to identify relevant studies regarding the use of CTA as ancillary test for BD confirmation. Guidelines for online search were followed, and the QUADAS 2 tool was used to verify study quality. Data from the studies retrieved were extracted aiming to perform the metaanalysis. Results: Ten low quality studies were found. Due to the absence of controls in all studies, specificity could not be calculated. Three hundred twenty-two patients were eligible for the metaanalysis, which exhibited 84,7% sensitivity. CTA image evaluation protocol exhibited variations between medical institutions regarding which intracranial vessels should be considered to determine positive or negative test results. Conclusions: For patients who were previously diagnosed with BD according to clinical criteria, CTA demonstrated high sensitivity to verify intracranial circulatory arrest. The current evidence that supports the use of CTA in BD diagnosis is comparable to other methods applied worldwide. Considering the importance of this subject, high quality studies are currently missing and needed.
Sami Kouki
Department of Radiology, Military hospital of Tunis, Tunisia
Title: A New Way for Establishing Vein mapping for creating Arterio Venous Fistula for Hemodialysis
Biography:
He has completed his PhD at the age of 26 years from medicine faculty of Monastir, Tunisia.Associate professor of radiology at university school of medicine of Tunis, Tunisia.Works in radiology department of the military hospital of Tunis where he has conducted research in vascular imaging in cooperation with vascular surgeons, resuscitator about the contribution of multidetector CT in the dysfunction of hemodialysis arteriovenous fistulas. He is directing researchs on network venous upper limb. He has published more than 15 papers.
Abstract:
Prospective study conducted over a period of thirty months until December 2015 in the department of radiology of the military hospital of Tunis. It has interested 57 patients with chronic renal failure at the stage of dialysis explored by upper limbs veinography and CT veinography. Both techniques were first compared for their quality. Thereafter, we compared their sensibilities and specificities in detecting various venous segments of upper limbs and in studying venous feature
The tow the tow tech were comparable for the detection of superficial venous system of the upper limbs (p= 0.240) and for their quality (p=0.065), which was excellent in 66.6 % of CT veinography. There was a statistically significant difference between the sensitivities of the two techniques in the in detecting distal (p<10-3) and proximal deep venous system (p=0,010), in studying reports and in highlighting certain anatomical variants (p=0,001). The CT veinography was less irradiating with a reduction in the contrast medium injected dose by 83% compared to veinography.
The upper limbs CT venography is a non invasive technique easly performed and interpreted. It is a reliable and reproducible imaging technique with high sensitivity and specificity offering a complete upper limb venous mapping before creating an AVF for hemodialysis.
- Pediatric Vascular Medicine
- Vascular Surgery
Session Introduction
De Vleeschauwer
Cologne University School of Medicine
Title: Carotid Bifurcation Resection and Interposition of a Polytetrafluorethylene Graft (BRIG) for Carotid Disease : alternative to the CEA?
Biography:
De Vleeschauwer Ph has completed his PhD at the age of 25 years from the University of Leuven and postdoctoral studies from the Cologne University School of Medicine.. He has published more than 20 papers in reputed journals and has been serving as an editorial board member of ”Annals of Vascular Surgery”.
Abstract:
Carotid endartectomy (CEA) is the gold standard for the treatment of carotid artery stenosis . CEA can be challenging, even technically impossible. An alternative technique is carotid bifurcation resection and interposition of a polytetrafluorethylene graft (BRIG).
In our Department of Vascular Surgery 130 BRIG procedures were performed between 2006 and 2015.
All procedures were performed by 1 surgeon.
The majority of procedures were for occlusive disease (98%) and 40% of the patients had a symptomatic stenosis. Procedure time and clamping time were significantly shorter in the BRIG group compared to the CEA group, performed by the same surgeon. A shunt was never used.
The 30-day mortality was 0,8%. The stroke rate was 1,5% (2 patients). These 2 patients had a minor stroke. One stroke was because of graft kinking which led to graft thrombosis. A thrombectomy and shortening of the graft was performed. In the second case , cerebral hypoperfusion was caused by a long clamping time combined with an incomplete circle of Willis ( absence of anterior and posterior communicating artery).
Mean follow-up time was > 30 months . Only 2 restenosis and 2 graft occlusions were observed.
The 2 restenosis occured at the proximal anastomosis and none at the distal anastomosis. We hypothesize that this is due the lower peripheral resistance of the cerebral circulation.
A minor stroke occured in both occlusions of the graft.
BRIG is a promising alternative option in the treatment of carotid artery disease.
Surgical technique is simplified. There is no need for an endarterectomy, distal intima fixation is no longer required and there is no thrombogenic surface left behind.
Our results of the BRIG technique in terms of mortality, morbidity and restenoses are better than the CEA.
In order to confirm these excellent results, prospective studies in a larger population are required
Qing Huang
Vice director of Neurosurgery department, Director of interventional neuroradiology department, Director of NICU,
Title: Treatment experience of ruptured posterior circulation aneurysms in acute period
Biography:
Qing Huang, male, 46 years old, Chinese, M.D.
Vice director of Neurosurgery department,
Director of interventional neuroradiology department,
Director of NICU,
Associate Senior Doctor, Department of Neurosurgery, Beijing Luhe Hospital, Capital Medical University, Beijing, P.R.China. 101149
Committee member of the Professional Committee of China Gerontological Society of cardiovascular and cerebrovascular disease,
Committee member of the Professional Committee of China Gerontological Society of hypertension disease,
Committee member of the American Congress of Neurological Surgeons,
Contributing editor of Chinese Journal of clinicians (Electronic Edition)
Member of National Science and technology expert database of Ministry of science and technology,
evaluation experts of Beijing Natural Science Foundation
Abstract:
Objective: To analysis the operative treatment of ruptured posterior circulation aneurysms in acute period. Methods: Retrospective analysis the clinical materials of 11 cases with 13 posterior circulation aneurysms in acute period of subarachnoid hemorrhage(SAH), which were management in our department during January,2014 to August, 2015. Including 2 aneurysms on the tip of basilar artery, one aneurysm of basilar-posterior cerebral artery, 5 aneurysms of posterior cerebral artery, one aneurysm of superior cerebellar artery, one aneurysm of anterior inferior cerebellar artery, 3 aneurysms of posterior inferior cerebellar artery. 2 cases were arteriovenous malformation(AVM) with blood flow correlation aneurysms, one case was moyamoya disease with blood flow correlation aneurysm. Four cases were treated by microsurgery clipping, four cases were treated by endovascular embolization, and the other three cases were treated by endovascular embolization plus microsurgery clipping. Results: The operations were successfully finished in all cases. The grades of Glasgow Outcome Scale(GOS) were evaluated after one month of operation, and 5 cases with grade 5, 4 cases with grade 4, one case with grade 3, one case with grade 1.Conclusion: Individualized treatment should be used in ruptured posterior circulation aneurysms. The relatively satisfactory curative effects could be achieved in both of the two methods, endovascular embolization and microsurgery clipping. But very poor prognosis would be received in ruptured posterior circulation aneurysms with high grade of Hunt-Hess scale.
Key words: posterior circulation aneurysms; acute period; microsurgery clipping; endovascular embolization
Petr Stadler
Na Homolce Hospital, Roentgenova 2, Praha, 15030, Czech Republic
Title: The Minimally Invasive Robotic Vascular Surgery
Biography:
Prof. Petr Stadler, M.D., Ph.D., Head Department of Vascular Surgery, Na Homolce Hospital in Prague, Czech Republic. He was certified as a console surgeon for the da Vinci surgical system in August, 2005 at the University of California, Irvine. Dr. Stadler is a member of the Czech Association of Cardiovascular Surgery, the ESVS, the ISMICS, the SRS and a founding member of the International Endovascular and Laparoscopic Society. He has also received a few prestigious honors from the Czech Association of Cardiovascular Surgery for the best publications in 2004 and 2006, the Letter of Appreciation from Korean Society of Endoscopic and Laparoscopic Surgeons in May 2008, the price of the Czech Society of Angiology for the publication in the year 2007 and the best audiovisual presentation in 2009 in USA (ISMICS) and in 2013 in USA (SCVS). He performed also the robot-assisted vascular operations in South Korea, Russia, Poland and India
Abstract:
The da Vinci system has been used by a variety of disciplines for laparoscopic procedures but the use of robots in vascular surgery is still relatively unknown. The feasibility of laparoscopic aortic surgery with robotic assistance has been sufficiently demonstrated. Our clinical experience with robot-assisted vascular surgery performed using the da Vinci system is herein described.
Between November 2005 and September 2015, we performed 342 robot-assisted vascular procedures. 245 patients were prospectively evaluated for occlusive diseases, 70 patients for abdominal aortic aneurysm, four for a common iliac artery aneurysm, five for a splenic artery aneurysm, one for a internal mammary artery aneurysm five for hybrid procedures, three for median arcuate ligament release and nine for endoleak II treatment post EVAR.
327 cases (95,6%) were successfully completed robotically, one patient's surgery (0,3%) was discontinued during laparoscopy due to heavy aortic calcification. In fourteen patients (4%) conversion was necessary. The thirty-day mortality rate was 0,3%, and early non-lethal postoperative complications were observed in six patients (1,75%).
- Advance Approaches to Vascular Disorders
Session Introduction
Sung-Kon Ha
Department of Neurosurgery, Korea University medical Center Ansan Hospital
Title: Bilateral STA flow change analysis for the evaluation of postoperative results after STA-MCA bypass
Biography:
Sungkon Ha M.D., PhD. is an associate professor of Department of Neurosurgery, Vascular divison, Korea University Medical Center, Ansan Hospital. Professor Ha completed his M.D. in 1999 and Ph.D. in 2009 at Korea university. He certified board of Neurosurgery in 2004 and board of endovascular surgery in 2013 in republic of Korea. He was a visiting scholar at the department of neurosurgery, Kyoto university, Japan in 2010 and clinical observor at the department of neurosurgery, UC Irvine, USA in 2015.
Abstract:
STA-MCA anastomosis has been used as a potential treatment option for the occlusive cerebrovascular disease. On postoperative CTA, MRA and DSA can show the patency of donor artery. However, these study were more expensive and invasive than ultrasound study. After the STA-MCA anastomosis, the flow rate of donor artery would be increased and this is the indirect evidence of patency of donor artery. We analyze the bilateral STA flow change at the pre and post-operative periods for the evaluation of relationship between donor artery patency and flow change.
- Vascular Bleeding Disorders
- Vascular oncology