The controversy around the treatment of infrarenal abdominal aortic aneurysm necks of less than 15mm will spark the discussion in the Abdominal Aortic Controversies Day of this year’s CX Main Programme. Delegates will also hear the latest evidence on the best way to manage a ruptured aneurysm and will have the opportunity to discuss whether too many patients with ruptured abdominal aortic aneurysms are being denied intervention. In addition, the controversy regarding radiation damage to the operator and the patient will be addressed and a series of clinical approaches for elective aneurysm repair will be discussed.
“The management of the aortic neck of less than 15mm is certainly very controversial,” says Roger Greenhalgh (Imperial College, London, UK), chairman of the CX Programme Organising Board. Therefore, he comments, “We will try to address every possible way of treatment.”
Commenting on endovascular aneurysm repair (EVAR) for short necks, Andrew Holden (Auckland City Hospital, Auckland, New Zealand), member of the CX Programme Organising Board, says: “We are aware that using EVAR to treat infrarenal aneurysms with hostile necks has been historically associated with higher aneurysm-related morbidity and mortality. Can new EVAR technologies and techniques change this paradigm?”
Delegates will have the opportunity to hear about the latest evidence regarding EVAR, open surgery and new technologies that are addressing the treatment of infrarenal abdominal aortic neck at the CX Abdominal Aortic Controversies Day (Wednesday 29 April). (Read an interview on the subject with Frans Moll, co-chairman of the CX Programme Organising Board).
Management of ruptured abdominal aortic aneurysms
The latest evidence on the best way to manage a ruptured aneurysm will be presented including the one-year results of the IMPROVE trial and the IPD 3 trial. In the same session, the controversy as to whether many patients with ruptured abdominal aortic aneurysms are denied intervention will be discussed.
Greenhalgh comments: “Perhaps doctors are becoming more concerned about operating for fear of having poor mortality figures. We need to find evidence whether indeed patients are denied intervention.”
Janet Powell (Imperial College, London, UK), member of the CX Programme Organising Board, considers that a few patients are offered repair of ruptured aortic aneurysm because perhaps “not all centres have an endovascular team and facilities available at all times; additionally, there are financial stringencies on healthcare systems and many of these patients may need intervention out of hours.”
Holden adds that many questions on this subject remain unanswered: “Do we have sufficient data to support an ‘EVAR first’ approach for ruptured abdominal aortic aneurysm repair patients? If not, who should be offered EVAR? Does the lower early morbidity associated with EVAR mean more ruptured aneurysms should be treated?”
These and other questions will stir a debate on the subject to be led by Matt Thompson (St George’s Vascular Institute, London, UK) and Peter Lamont (North Briston, NHS Trust, Bristol, UK).
Radiation exposure concerns
Additionally, in the CX Abdominal Aortic Controversies Day, strategies for radiation exposure reduction to the operator and to the patient will be discussed in a mini-symposium. Members of the CX Programme Organising Board consider this subject a top priority in the field. Greenhalgh comments: “The risk of radiation damage to the operator and to the patient is now known to be serious and many physicians have damaged themselves trying to treat their patients.” Powell adds: “Many of the early pioneers of EVAR/TEVAR are now dying of cancer. The importance of reducing radiation burden and safety is one of the key contemporary issues that need to be addressed.”
Subsequently, delegates will learn about a series of clinical approaches for elective aneurysm repair including the latest evidence on a new iliac branch endoprosthesis and treatment strategies for octo- and nonagenarians.
Moreover, the long-term follow-up of EVAR after 20 years of introduction will be also addressed. Holden comments: “The optimum follow-up protocol after EVAR is also likely to be controversial. This is an important discussion as post-procedural surveillance is a major cost contributor to EVAR.”
The CX Abdominal Aortic Day will close with a mini-symposium on the management of type I endoleaks.
The CX Abdominal Aortic Controversies Day will take place at the Charing Cross Symposium on Wednesday 29 April – Main Auditorium, Olympia Grand, London, UK
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