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The Take Home: ISET
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Image: International Symposium on Endovascular Therapy
The 25th annual International Symposium on Endovascular Therapy took place this past January in Miami Beach. The 5-day multidisciplinary meeting featured trial data, debates, posters, case reviews, live case demonstrations and firsthand clinical accounts on topics spanning the growing field of endovascular therapeutics.
At the meeting were Gary M. Ansel, MD, system medical chief, vascular services, Ohio Health/Riverside Methodist Hospital, Columbus, Ohio, and Michael Nguyen, MD, PhD, specialist in interventional radiology and cardiovascular imaging at Houston Progressive Radiology Associates, who provided Cardiology Today’s Intervention with their take on the most important sessions presented during the symposium.
Gary M. Ansel, MD
This year’s International Symposium on Endovascular Therapy (ISET) meeting was the 25th anniversary, which is an awesome testament to Barry Katzen, MD, and his group. They did a great job and really tried to step out of the box by creating some different educational approaches and topics that hadn’t been addressed before.
Drug-Elution for SFA Disease
Gary M. Ansel
Among the topics I found of particular interest was the use of drug elution, both from drug-eluting balloons and drug-coated stents, for superficial femoral artery (SFA) disease. I was on the panel for this discussion and really enjoyed the back and forth on lower-extremity revascularizations and comparing the European approach to the American approach.
There was also a presentation by Mark Burket, MD, on the potential financial ramifications of device selection for peripheral intervention, which took a different spin on it. In the future I do believe we’ll be looking at trying to become more long-term patency-directed with a lot of these procedures.
The Business Side
Another session that stood out involved strategies for success in the changing health care economic environment, which looked at some of the business aspects of practice and how they are going to change in the United States. Michael Jaff, MD, led a group with Katzen looking at the accountable care organizations and the employed physician topics that are much more relevant today than they were 10 years ago.
There was also a role-playing exercise, which is something you don’t see at many meetings, which added a lot of insight into this topic for the attendees because it is such a big trend in the United States. We were able to see groups of physicians and health care professionals on both sides of the aisle role playing to deal with very real situations.
Techniques, LINC in the Spotlight
During the meeting, presenters shared a lot of detail concerning abdominal aortic aneurysm stent grafting, including data on some of the new techniques, such as percutaneous profile, fenestrated devices and other device modifications, which may expand treatment beyond the current indications and patient populations. The sessions were well attended and I heard a lot of buzz about the case studies that showed how to perform these different techniques.
Added to which, the partnership with Leipzig Interventional Course (LINC) was pulled off very well, both with the live cases and the sharing of lectures across the ocean. It was nice to have a give and take with our European colleagues and learn from their perspectives and vice versa.
Disclosure: Ansel is on the advisory panel for Abbott Vascular, Cordis Endovascular, Covidien, C.R. Bard, Medtronic, TriVascular and W.L. Gore.
Michael Nguyen, MD, PhD
Michael Nguyen
Due to clinical significance, technical advances and cost effectiveness, minimally invasive endovascular therapy has now transcended many specialties — interventional radiologists/neuroradiologists, interventional cardiologists, vascular surgeons and CV surgeons. The organizers of ISET recognized this by creating a multidisciplinary institution now known as Baptist Cardiac and Vascular Institute. They also recognized that endovascular progress requires recognizing the impact of research and clinical advancement abroad. They took that practice philosophy and have instilled it in every ISET conference.
International Presence
Our South American endovascular brethrens contributed their knowledge and expertise regarding emerging therapies during this year’s new “ISET meets the Americas.” Notably, Francisco Carneval, MD, PhD, presented solid evidence regarding the effectiveness and advantages of prostate artery embolization (PAE) for benign prostate hypertrophy (BPH) treatment that has emerged from South America. PAE provides a significant option for BPH treatment in a continuing aging population. Continued collaboration with our German cohorts was again demonstrated the last day with the simultaneous LINC and live cases.
Renal Denervation
The topic of greatest discussion during the meeting was renal denervation, due to its potential impact on not only hypertension, but also HF, diabetes and sleep apnea. Marc Sapoval, MD, PhD, and Mel Lobo, PhD, presented data, including from the SYMPLICITY HTN trials, that support the tremendous potential impact renal denervation can have on treating drug-resistant hypertension, which has already proved successful in Europe. Considering that hypertension is the most commonly diagnosed condition, the largest contributor to mortality worldwide and that 20% to 30% or more of patients cannot be controlled with three or more medications, the anticipation for renal denervation in the United States is definitely warranted. Yet, we cannot dismiss Sapoval’s cautious words that successful implementation requires that “we advocate for calm and reasonable adoption.”
Live Cases Highlight AAA Repair
The live sessions demonstrated a further significant evolution in the types of endografts available for abdominal aortic aneurysm (AAA) repair with various fenestrated grafts on the horizon. Aside from endografts themselves, during a live AAA repair case, Barry Katzen used an endovascular robot (Hansen Medical Magellan) to access the contralateral limb gate. James Benenati, MD, used a clever method, the “kilt technique,” to treat an AAA with a short proximal neck and bi-lobed aneurysm.
Image: International Symposium on Endovascular Therapy
Vascular Disease Sessions
Multiple sessions also emphasized clinical evaluation and management of vascular disease. From “soups to nuts,” a full day was dedicated to clinical workup and treatment of arterial and venous disease. Similarly, sessions regarding deep vein thrombosis workup and management, and stroke workup and management provided a detailed introduction and solid review for both novice and experienced physicians.
The Final Take Home
Reflecting an enlarging and aging population and continued rising health care costs, we are in the midst of health care reform that emphasizes effective and cost-conscientious medicine. Endovascular therapy will continue to grow, both in volume and in technical advancement, because it can best serve the reality of medicine today. Renal sympathetic denervation, PAE, endovascular endografts and the potential of bioabsorbable stents represent the tremendous impact that we as endovascular clinicians can provide in today’s current health care climate.
Disclosure: Nguyen reports no relevant financial disclosures.