November 2024 / Issue 104
www.vascularnews.com
NORTH AMERICAN EDITION Featured in this issue:
4 R adiation protection and pregnancy
New research published
6 Uncomplicated type B aortic dissection Putting biases aside
16 P rofile
24 Deep vein thrombosis AI-assisted diagnostic pathway presented
Ramon Varcoe
ESVS
ESC
New ESC guidelines combine peripheral arterial and aortic diseases for first time
Innovation in vascular surgery: Balancing progress with patient safety A debate at this year’s European Society for Vascular Surgery (ESVS) annual meeting (24–27 September, Kraków, Poland) centred on innovation in vascular surgery, with experts considering whether it will ‘change everything’ in the field. While Matt Thompson, chief executive officer of Endologix, underscored the inherently innovative nature of vascular surgery and the inevitability of technological advancement— he urged specialists to “safely adopt new technologies or become irrelevant”—vascular surgeon Jon Boyle (Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK) championed a more cautious, patient safetyfocused approach, highlighting past instances of innovation having caused harm.
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hompson began by arguing that vascular surgery is, at its core, an innovative specialty. He cited several historical examples of disruptive advancements in the field, from John Hunter ligating peripheral aneurysms 200 years ago, to the advent of open surgery and the subsequent endovascular revolution, all of which ushered in new and distinctive eras of
treatment and fundamentally changed the vascular surgery landscape. In the ongoing endovascular era, Thompson put forward, several innovations—including bioresorbable stents and non-invasive devices—have refined, or are set to refine, longstanding techniques and technologies. Indeed, the presenter said, there is “still room” for endovascular innovation despite the largely unchanging nature of its fundamental building blocks. However, these innovations will not, in Thompson’s view, ‘change everything’ in vascular surgery. Instead, he argued that the next paradigm shift in the field will be defined by the accelerated pace of technological change that is happening in the wider world. Thompson argued that the pace of technological advancement in society has already led to “enormous” changes in how people live their lives. “It took 2.4 million years for humans to learn to control fire, but only 66 years to go from the first flight to humans landing on the moon,” he said. The presenter continued that technology can change the world in ways that are unimaginable until they happen, noting, for example, that “switching on an electric light would have been unimaginable for our medieval ancestors”. This is only compounded by the accelerating pace at which technology is
There’s going to be some technological advance that completely changes our practice” — Matt Thompson
THE EUROPEAN SOCIETY of Cardiology (ESC) recently published its 2024 guidelines for the management of peripheral arterial and aortic diseases (PAAD), evaluating these vascular conditions together as part of the same cardiovascular system. The guidelines are aimed at cardiologists but were coordinated for alignment with guidelines for surgeons by the European Association for Cardio-Thoracic Surgery (EACTS) and endorsed by the European Reference Network on Rare Multisystemic Vascular Diseases (VASCERN) and the European Society of Vascular Medicine (ESVM). “These updated guidelines have been introduced now due to significant advancements and shifts in our understanding and management of aortic and peripheral arterial diseases (PAD), including new treatment modalities, since the last guidelines were published in 2014 and 2017, respectively,” says ESC guidelines co-chair Jose Fernando Rodriguez Palomares (University Hospital Vall d’Hebron, Barcelona, Spain). “The decision to integrate these guidelines is based on several key factors. The aorta and peripheral arteries are integral components of the same arterial system. Disorders in one part of this system often have implications for the other,” adds co-chair Lucia Mazzolai (Lausanne University Hospital, Lausanne, Switzerland. “Combining the guidelines provides consistent and standardised recommendations for the management of arterial diseases Continued on page 4
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