Conference Schedule

Day1: May 24, 2018

Keynote Forum

Biography

Patrick Kelly studied Civil Engineering in the University of Wyoming before attending medical school. He is a Board Certified Vascular Surgeon at Sanford Health. He has pioneered several surgeries including the first complete endovascular aortic arch aneurysm repair in the world. He works with the FDA and the Society for Vascular Surgeons on clinical trials for complex aneurysm repair and recently published a template which guides vascular surgeons through the process of applying for- and conducting-physician-sponsored investigational device studies. He is an active inventor of medical devices with over 180 issued or pending patents. Sanford Health and Medtronic, PLC entered into an exclusive worldwide licensing agreement with the intention of commercializing his technology for repairing thoracoabadominal aortic aneurysms. He has an active PS-IDE clinical trial for this device. His experience and expertise allows him to have valued insight while developing new technologies to better care for patients.
 

Abstract

Objective: To review the clinical results of the use of investigational visceral manifold for the revision of failed abdominal and thoracic aortic aneurysm repairs. Methods: A single center patient database was utilized to retrospectively review 25 patients who had a revision procedure using the visceral manifold stent graft system following previous abdominal or thoracic aortic aneurysm repair. Results: Technical success was achieved in 23 out of 25 patients treated, with 89 of the intended 92 visceral vessels being successfully stented. Two in-hospital deaths were recorded. To date, no device integrity related failures have been observed. Conclusions: Early- and mid-term results of the use of visceral manifold stent graft system suggest a potentially viable option for the revision of failed aortic aneurysm repairs. However, experience is limited and this approach needs to be studied further before widespread adoption. 

Biography

Dong Ik Kim is a Vascular Surgeon and currently holds the position of Chief of Vascular Surgery, Samsung Medical Center, Professor of Sungkyunkwan University School of Medicine, President of Korean Society for Diabetic Foot, Congress President of Diabetic Limb Salvage in Asia, President of Korean Society for Stem Cell Research, Chairman of the Board of Directors of Korean Society for Vascular Surgery. Also, he served as Congress President of 2015 Seoul UIP, President of Asian Venous Forum, President of Korean Society for Phlebology and Editor-in-Chief of International Journal of Stem Cells. He is a member of the American College of Surgeons, Asian Society for Vascular Surgery and many of International Societies. He has been studied in the field of stem cells for angiogenesis, tissue engineering, carotid surgery and vascular malformation. He published more than 150 international articles and about 100 domestic articles. He also published six numbers of medical textbooks as a Chief Editor.
 

 

Abstract

Objective: Debate about carotid endarterectomy (CEA) and carotid stenting (CAS) efficacies continues despite many reports. The aim of this study was to evaluate the early outcomes and restenosis rate of CEA versus CAS using propensity score matching (PSM). Methods: Retrospective review of database was conducted for the patients who underwent CEA or CAS between January 2002 and December 2015 at a single institute. We investigated the 30day incidence of a major adverse clinical event (MACE; defined as stroke, transient ischemic attack, myocardial infarction or death) and procedure related complication, restenosis rate during the follow up period. PSM were used to create a balanced group of CEA and CAS patient who were matched for following factors: age, gender, hypertension, diabetes, dyslipidemia, smoking, atrial fibrillation, previous percutaneous coronary intervention or coronary artery bypass grafting, valvular heart disease, contralateral carotid occlusion, degree of carotid stenosis, and symptomatic status. Comparisons of outcomes in this matched group of patients were performed using logistic regression analysis and log rank test. Results: Among total 1184 patients (654 CEA and 530 CAS), matched groups of 452 CEA and 452 CAS were created after PSM. Within the propensity-matched group, the CAS group was showed higher 30-day incidence of MACE (7.5% vs. 2.4%; OR [odd ratio] 3.261; 95% CI [confidence interval], 1.634-6.509; p=0.001) but lower incidence of procedure related complication (1.5% vs. 5.3%; OR, 0.199; CI, 0.075-0.528; p=0.001). The CAS group showed higher restenosis rate (1.5% vs. 1.0% at 12 months, 5.4% vs. 1.2% at 24 months; p=0.008) than CEA group during the mean 49.1 months follow up period (range, 1-180 months).
Conclusion: In this study based on propensity score matching analysis, CEA showed lower 30-day incidence of major adverse clinical event and restenosis rate during the follow up period than CAS for revascularization of carotid artery stenosis. 

 

Biography

Geng Long Hsu is a Clinical Professor at China Medical University. He has developed and refined a series of penile reconstructive surgeries, including penile venous surgery, corporoplasty and penile implantation, in tandem with advances in knowledge of the penile venous and tunical anatomy and of erection physiology. In 1993, he was promoted to the first Chair of Urology at Taiwan Adventist Hospital; he held that position until 1997 and then served as Vice-Superintendent of Po-Jen General Hospital until 2001. From 2001 to 2003, he was the Director of Microsurgery Potency Reconstruction at Taipei Medical University Hospital. Afterward, he has established his private practice—Hsu’s Andrology which serves as both a clinical practice and research center. In 2012, his latest method of penile venous stripping surgery, administered via local anesthesia on an ambulatory basis, was granted a USPTO patent. He hopes this surgery will be studied and practiced worldwide.
 

Abstract

We have refined penile venous stripping, penile corporoplasty and varicocelectomy for patients with erectile dysfunction, penile dysmorphology and varicocele since 1999. From June 2010 to March 2016, a total of 128 men, aged from 28 to 68 years, consulted us with erectile dysfunction, penile deviation, and a varicocele. Among these, 87 males (the surgical group) underwent a combination of penile venous stripping, corporoplasty and varicocelectomy, while 41 were assigned to the control group without surgery. The abridged five-item version of the International Index of Erectile Function (IIEF-5), a dual cavernosography, and a life quality rating were used to assess patients. Under an acupuncture-aided pure local anesthesia on an ambulatory basis, these surgeries were performed. In the surgical group, the preoperative IIEF-5 and the life quality rating was 9.7±2.1 and 26.7±3.6%, which was increased postoperatively to 22.6±2.3 and 82.6±5.2% respectively (both p<0.001). Two men reported one and two children fertility postoperatively although their initial chief complaints were just impotence and penile curvature preoperatively. In the control group, the corresponding preoperative IIEF-5 and life quality rating was 9.8±2.3 and 27.4±3.7% respectively which changed to 8.9±2.4 and 20.9±6.3% respectively (latter p<0.01). The difference between the two groups (p<0.001) and within the group (p<0.01) was significant. A satisfactory penile shape was achieved in 79 (90.8%) patients with eight men (9.0%) complaining of mild deviation of the penis (<10°). Cavernosogram showed an ideal milieu of the corpora cavernosa for retaining intracavernous fluid which was particularly evidenced by significant stronger radiopacity of penile crura than that of the femoral cortex. A combination of penile venous stripping, corporoplasty and varicocelectomy provides a novel solution for restoring erectile function, penile morphologic reconstruction and fertility enhancement with negligible morbidity. Being assisted with acupuncture management outpatient basis is sustainable.

 

 

Tracks

  • Abdominal Aortic Aneurysms | Techniques of Open Vascular Surgery | Thoracic Aortic Vascular Surgery | Anesthesia For Vascular Surgery
Location: Johnson
Speaker

Geng-Long Hsu

Hsu’s Andrology, Taiwan

Chair

Speaker

Wei-liang Chen

Sun Yat-sen University, China

Co Chair

Biography

Since 1986, Geng-Long Hsu, formerly a clinical professor at China Medical University, has developed and refined a series of penile reconstructive surgeries, including penile venous surgery, corporoplasty and penile implantation, in tandem with advanced the penile anatomy and erection physiology. In 1993, he was promoted to the first Chair of Urology at Taiwan Adventist Hospital; he held that position until 1997 and then served as vice-superintendent of Po-Jen General Hospital until 2001. From 2001 to 2003, Dr. Hsu was a director of microsurgery potency reconstruction at Taipei Medical University Hospital. Afterward, he established his private practice—Hsu’s Andrology—which serves as both a clinical practice and research center. In 2012, Dr. Hsu’s latest method of penile venous stripping, administered via an ambulatory basis, was granted a USPTO patent. He hopes this surgery will be studied and practiced worldwide. I, Chun-Kai Hsu, am pleasurable to conduct this report in fellowship. 

Abstract

Despite topical anesthetic blockage for penile surgeries has been substantially reported in the medical literature, a heavy intravenous sedation is unexceptionally used. We sought to report an acupuncture assisted pure local anesthesia on the ambulatory basis under several methods of topical blocks. From 1989 to 2017, 3223 men (ages 19 to 91 years) received our ambulatory penile vascular surgeries. They were categorized into the venous (n= 2867), patch (n= 323), and arterial groups (n= 33) in accordance with penile venous stripping, penile autologous venous patches, and penile arterial reconstruction surgery respectively. The chosen acupoints involve Hegu (LI4), Shou San Li (LI10), Quchi (LI11) , and either Waiguan (SJ5) or Neiguan (PC6). In tandem with our advanced penile anatomy, the topical blocks include proximal dorsal nerve block, peripenile infiltration, bilateral crural blockage and topical infiltration. These blockages are sufficient local anesthesia for patients with varied vascular surgeries unless a penile implant which requires bilateral cavernous nerve block. The anesthetic effects when a visual analog scale of 100 mm was used, and postoperative results were satisfactory. Common immediate side effects included puncture of the corpus spongiosum or the deep dorsal vein as well as the innominate vessel, subcutaneous ecchymosis, transient palpitations, and acceptable low level of pain. There were no significant late complications. A booster injection is advised by 4 hours before the patient registers pain again. Overall 2635 men (81.5%) require 1 to 2 booster injections. In recent three years, 23 American and European males have successfully received this acupuncture-aided local anesthesia despite they insisted general anesthesia in threads of internet consultations before their attendances. Topical nerve blockades proved to be reliable, simple, and safe, with minimal complications. They offer the advantages of less morbidity, reduced effects of anesthesia, protection of privacy, and a rapid return to preoperative daily activity.
 

Biography

Since 1986, Geng-Long Hsu, formerly a clinical professor at China Medical University, has developed and refined a series of penile reconstructive surgeries, including penile venous surgery, corporoplasty and penile implantation, in tandem with advanced the penile anatomy and erection physiology. In 1993, he was promoted to the first Chair of Urology at Taiwan Adventist Hospital; he held that position until 1997 and then served as vice-superintendent of Po-Jen General Hospital until 2001. From 2001 to 2003, Dr. Hsu was a director of microsur-gery potency reconstruction at Taipei Medical University Hospital. Afterward, he established his private practice—Hsu’s Andrology—which serves as both a clinical practice and research center. In 2012, Dr. Hsu’s latest method of penile venous stripping, administered via an am-bulatory basis, was granted a USPTO patent. He hopes this surgery will be studied and prac-ticed worldwide. I, Yi-Wei Pai, am pleasurable to conduct this report in fellowship. 

Abstract

Erectile dysfunction (ED) concomitant with psychosis is common in adults younger than 30 years. Most cases are con-sidered entirely psychogenic in nature. Given that penile erection-related veins constitute the principal components in erectile rigidity in defrosted cadaveric he-modynamic studies; do venogenic factors dominate psychogenic factors in males with ED? Although phospho-di-esteraser-5 inhibitors have clarified current ED medi-cal treatment, resulting in a consensus on ED pathophysiology, the understanding of the erection process may yet be just at a fledgling stage. Clinically, the psychological factor plays a significant role because placebo effect affects approximately 40% of participants in clinical trials. Based on a novel penile venous anatomy and physio-logical osmolality and viscosity, an apa-gogical hemodynamic study was conducted on defrosted cadavers. Implying penile veins themselves are the most crucial fac-tors in erection physiology and that obvi-ously venogenic factors are inappropriately considered cavernosal factor in the list of ED contributors. According to our vast clinical experience, the penile venous stripping method proves to be an exclusive and naturally viable treatment option. The term young ED refers to males with ED who is younger than 40 years, whereas it strictly referred to males younger than 30 years in the three publications in our evi-dence based report. Those young ED males account for 10.3% (35/341) to 14.3% (5/35) (average, 12.1%) of the total patients with ED who underwent penile venous stripping. Erectile function is the seamless interplay of psychological and physiological health in adult males. Penile erection related veins play a principal role in erectile rigidity in cadaveric hemody-namic studies, and venoocclusive dys-function is prevalent in males with ED. However, psychological factors contribute some extent in ED and they should not be ignored during ED treatment. The role of the contribution also cannot be underesti-mated in impotence in males younger than 30 years.
 

Biography

Wei Liang Chen is a Professor, Chief Surgeon and Director, Center of Cranio-Maxillofacial Surgery of Sun Yat-sen University. He focus on the diagnosis and surgical treatment of oral and cranio-maxillofacial tumors including craniofacial resection and reconstruction in patients with recurrent cancer involving the craniomaxillofacial region, salvage surgery for patients with recurrent oral and oropharyngeal cancer involving the carotid artery and comprehensive treatment of hemangiomas, vascular malformation, arte
riovenous malformations and lymphatic malformations. He has received 14 grants from national and provincial research funds and has holding the national medical education on comprehensive treatment of oral and cranio-maxillofacial tumors from 2001 to 2017. More than 100 papers were published in international peer-reviewed journals

Abstract

Background: Involvement of the carotid artery (CA) is classified as a stage IVb disease, which is considered to be unresectable. Outcomes of salvage surgery and carotid artery (CA) management were evaluated in patients with oral and oropharyngeal cancer. Patients & Methods: Thirty-six patients with advanced recurrent oral and oropharyngeal SCC involving the CA underwent salvage surgeries and reconstruction with flaps. The age range of the 28 males and eight female patients was 46–72 years. Four patients suffered carotid blowout requiring emergency surgery. They underwent wide resection of the tumor with CA resection. Reconstruction with a vascular prosthesis was performed in eight (22.2%) patients; eight (22%) others underwent subadventitial dissection of the CA; four patients (11.1%) were treated by CA subadventitial dissection and encapsulation with a vascular prosthesis; and 16 patients (44.4%) underwent CA resection alone. Reconstruction of the major defect was performed in 22 patients (61.1%) with an extended vertical lower trapezius island myocutaneous flap or folded flap; 10 (27.8%) had a pectoralis major myocutaneous flap; two (5.6%) had a submental flap; and two (5.6%) had a forearm free flap. Results: All rCS IVb tumors were completely removed, and the tissue defects were successfully reconstructed with flaps. Postoperative transient hemiplegia occurred in two patients who underwent CA resection, but it resolved completely within 6 weeks. Four patients who underwent CA resection and reconstruction with a vascular prosthesis or CA subadventitial dissection suffered carotid blowout during the perioperative period; both were treated by ligating the CA. Two patients who underwent CA resection and reconstruction with a vascular prosthesis had a carotid embolism. None of the patients developed neurologic sequelae. After 3–46 months of followup, 24 patients (66.7%) had no evidence of disease, four (11.1%) showed evidence of disease, and eight (22.2%) died of local recurrence or distant metastases at 5–36 months. 
Conclusions: Although these percentages are far from optimal, salvage surgery currently offers effective treatment without major complications for patients with rCS IVb oral and oropharyngeal SCC involving the CA. CA sacrifice offers a viable treatment strategy. Major defects can be reconstructed with a trapezius flap. 

Biography

Aleksandra Piechota Polanczyk is currently employed as an Associate Professor in the Department of Medical Biotechnology, at the Jagiellonian University in the frame of the project entitled “Role of heme oxygenase 1 in the development and progression of abdominal aortic aneurysm”. She received her PhD in Medicine with specialty of Medical Biology in 2011. She was a leading researcher in Prof. Ihor Huk research group (VASLAB) at the Medical University of Vienna, Austria with whom she is now cooperating. Her research interests focuses on finding of new anti-oxidative and anti-inflammatory proteins that could be potential markers and/or targets in treatment of gastrointestinal and cardiovascular diseases, as well as the role of Nrf2 and heme oxygenase 1 in cellular adaptation to oxidative stress and inflammatory reactions.. 

Abstract

Statement of the Problem: Nuclear factor (erythroid-derived 2)like 2 (NRF2) is a global antioxidant gene inducer whose activity may regulate metabolism of extracellular matrix proteins including collagen. It was shown that human abdominal aortic aneurysm has increased deposition of collagen I and reduced of collagen III in tunica media and adventitia. The synthesis of collagen I is controlled by transforming growth factor beta 1 (TGFb1). Therefore, the purpose of this study was to describe localization of structural collagens within the aorta and aortic aneurysm in transcriptional knockouts of Nrf2 and to verify the mechanism behind those changes. Methodology & Theoretical Orientation: We used a model of angiotensin II (Ang II)-induced abdominal aortic aneurysm in old adult mice (6 mo.) with transcriptional knockout of Nrf2 (Nrf2 -/-) and with normal activity of Nrf2 (Nrf2 +/+). Mice were administrated with Ang II (1000 ng/kg/min) or saline (sham group) for 28 days via osmotic minipumps placed subcutaneously. After 28 days tissue specimens were collected for immunofluorescence and analysis of gene expression. Findings: Ang II-treatment caused a significant increase of collagen I mRNA expression in tunica adventitia and a strong increase of collagen III expression in tunica media. The observed upregulation of collagen type I and III was significantly higher in mice lacking transcriptional Nrf2. An increase in collagens was associated with significantly higher TGFb1 only in the Nrf2 -/- mice. Conclusion & Significance: Transcriptional factor Nrf2 may play a significant role in collagen deposition during abdominal aortic aneurysm formation and excessive collagen synthesis 
may be associated with TGFb1 activation in the Nrf2-/- mice.
 

Biography

Agnieszka JabÅ‚oÅ„ska of the Institute of Medical Biology of the Polish Academy of Sciences has an experience in Molecular Virology. In her studies, she is aiming to understand the detailed molecular mechanism of viral infection and the host-pathogen interactions. Elucidation of biological significances of pattern-recognition receptors (PRRs) signaling pathways in which viruses are implicated is also one of her goals. Furthermore, she has tried to reveal the associations between the PRRs expression, single nucleotide polymorphism within TLR genes and the predisposition for abdominal aortic aneurysm development. 

Abstract

Statement of the Problem: Toll-like receptors (TLRs) are a family of highly conserved, transmembrane proteins that recognize a wide spectrum of pathogen-associated molecular patterns (PAMPs) and activate innate immune response. It was recently shown that TLR2, TLR3, and TLR4 signaling contributes to abdominal aortic aneurysm (AAA) formation and development. However, there are no studies regarding the association between single nucleotide polymorphisms within TLR genes and the incidence of AAAs. The aim of this study was to determine the prevalence of TLR2, TLR3, and TLR4 polymorphisms, and investigate the relationship between these polymorphisms and AAA risk. Methodology & Theoretical Orientation: The presence of the seven TLR SNPs was studied using polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP), whereas a selected cytokine levels were quantified by enzyme-linked immunosorbent assays (ELISAs). Findings: The heterozygous genotype of the SNP rs121917864 of TLR2 was detected more frequently in patients with AAA and was associated with an almost six-fold increased risk of AAA (P<0.001) and larger aneurysm size (P=0.037). In contrast, a relationship between the heterozygous CA genotype of TLR3 SNP rs3775296 and diminished risk of AAA formation and development was found (P<0.001). Conclusion & Significance: The heterozygous genotype of TLR2 SNP rs121917864 may be a predictor of AAA formation, while TLR3 SNP rs3775296 seems to exert an independent protective effect. It is therefore essential to identify the host determinants of aneurysm formation in humans and understanding the role of the selected TLRs SNPs in the pathogenesis of AAA.

Biography

Andrzej Polanczyk is a Researcher and a Team Leader at the Lodz University of Technology (Poland). He earned a PhD in Medical Engineering in 2013. He participated in scientific grants in which he build the installation to simulate the blood flow through the abdominal section of the aorta. Recently he received a grant funded by the National Centre for Research and Development. His research areas comprise biomedical, chemical and environmental engineering. 

Abstract

Introduction: We aimed to verify the accuracy of computational fluid dynamics (CFD) algorithm for blood flow reconstruction for type IIIb aortic dissection (TBAD) before and after thoracic endovascular aortic repair (TEVAR). Methods: 3D models of the aorta with adjacent arteries were prepared using pre- and post-operative CT data from five patients treated for TBAD. The displacement forces acting on the aortic wall in the areas of endograft, mass flow rate/velocity and wall shear stress (WSS) was calculated with CFD technique. Results were verified with ultrasonography (USG) data. Results: CFD results indicated that TEVAR procedure caused 7-fold improvement in overall blood flow through the aorta (p=0.0001). The accuracy of CFD calculations for pre-TEVAR vs. post-TEVAR were 90% and 96%, respectively. Results from CFD also indicated a significant increase in flow rate for thoracic trunk and renal arteries, which was in accordance with USG data (accuracy 90% and 99.9%). Additionally, a significant decrease in wall shear stress (WSS) values within the whole aorta after TEVAR compared to pre-TEVAR was showed (1.34±0.20 Pa vs. 3.80±0.59 Pa, respectively, p=0.0001). This decrease was provided by a significant reduction in WSS and WSS contours in the thoracic aorta and renal arteries. Conclusions: CFD technique confirmed that post-operative remodeling of the aorta after TEVAR for TBAD improved hemodynamic patterns reflected by flow, velocity and WSS with accuracy of 99%. 

Biography

Chi Can Huynh graduated from Sydney University in 1999. During his senior years in Medical School he completed a Surgical Research Term with Tom DeMeester at the University of Southern California. He was accepted into 
the Advanced General Surgical training scheme in 2003 and then onto the Advanced Urology Training Program in 2005. He was the inaugural Robotic Fellow at St. Vincent’s Prostate Cancer Centre in 2008. Following this, he spent 18 months in Manchester (United Kingdom) completing a laparoscopic prostate fellowship. He has interests in erectile restorative surgery and robotic prostate surgery and was the first in Australia to perform a robotic assisted radical nephro-ureterectomy and penile erection restorative vein surgery. His research interests are in erectile dysfunction and he is a part time fellow in erectile restorative surgery overseas. He co-authored papers in peer reviewed medical journals and presented multiple international conferences on the topic. He also holds teaching positions with the Rural Medical School of the Australian National University and the Australian School of Advanced Medicine. 

Abstract

Conventional pharmaco-cavernosography including CTcavernosography provides little information on penile venous anatomy, although it is acceptable in documenting venoocclusive erectile dysfunction (ED). We report an innovative method, which can exclusively provide penile venous anatomy for guiding penile venous stripping. From July 2010 to November 2017, 896 impotent men, aged 20 to 75 years, underwent this method of pharmaco-cavernosography in which two sets of 60mL of 50% omnipaque solution were administered intracavernously. The first set of pilot cavernosograms was taken at intervals of five, ten, twenty and thirty seconds after the commencement of the injection. The second set of cavernosograms was taken in the same intervals within 30 minutes following the pilot set, preceded by the injection of 20 µg prostaglandin E1 (PGE1). For comparison, the pilot cavernosograms were routinely performed immediately postoperative on the patient undergoing penile venous stripping. An analysis was conducted on the drainage veins including deep dorsal vein (DDV), cavernosal veins (CVs) and para-arterial veins (PAVs) accordingly. The veins demonstrated in the pilot cavernosograms, and the second set was compared in terms of venous numbers and presentation percentage. A radio-opacity of the penile crura and that of the femoral cortex was made. There was a statistically significant difference (P<0.001) between the total number of independent venous drainage channels and the presentation percentage of DDV, CVs and PAVs observed in the pilot cavernosograms, and those in second set (4.5 vs. 2.1; 97.48%, 60.35%, and 38.93% vs. 57.08%, 29.37%, and 19.07%, respectively). A stronger radioopacity of the penile crura is unexceptional noted. Compared with conventional pharmaco-cavernosography methods, pilot cavernosograms are readily able to show detailed penile venous anatomy which is indispensable for guiding venous stripping surgery. It is, therefore, may be concluded that pilot cavernosograms are an exclusively valuable addition to conventional of pharmaco-cavernosography and CT-c protocols avernosography.
 

Biography

Branislav Zagrapan is pursuing his PhD on the topic of molecular and cellular diagnostic and prognostic markers of abdominal aortic aneurysms. He is a Pathologist in training at the Academic Teaching Hospital Feldkirch, Austria 

Abstract

Background: The pathogenesis of abdominal aortic aneurysm (AAA) involves a central component of chronic inflammation which is predominantly mediated by myeloid cells. Both, neutrophils and monocytes are recruited to the AAA wall and intraluminal thrombus and contribute to vessel destruction by the release of proteases and reactive oxygen species. Purpose: We hypothesized that the local activation of myeloid cells may be reflected in systemic alterations of neutrophil and monocyte populations as well as in associated soluble factors which might serve as biomarkers to diagnose the oftenasymptomatic disease. Methods: The methods of this study were to establish their diagnostic marker potential, neutrophil and monocyte subsets were measured by flow cytometry in peripheral blood samples of 41 AAA patients and 38 healthy controls matched for age, sex, body mass index and smoking habit. Comparably, circulating factors relating to myeloid cell activation and recruitment were assayed in plasma by multicytokine array and ELISA. Results: Significantly elevated levels of CD16+ monocytes, activated neutrophils and newly released neutrophils were recorded for AAA patients compared to controls. In line, the monocyte chemoattractant protein 1 and myeloperoxidase were significantly increased in patients´ plasma. The diagnostic value was highest for myeloperoxidase, a mediator which is released by activated neutrophils as well as CD16+ monocytes. Comparison of the investigated myeloid factors with established AAA parameters by multivariable logistic regression identified myeloperoxidase and D-dimer as highly significant, independent variables. These two biomarkers were combined to yield a potent diagnostic score which was subsequently confirmed in a validation cohort. Conclusions: Based on a comprehensive comparison of myeloid cell activation parameters, plasma myeloperoxidase 
was identified as the most potent AAA biomarker. Since D-dimer and myeloperoxidase represent two sensitive markers of AAA which reflect distinct components of the AAA pathomechanism (thrombus formation and inflammation) they may be combined to yield an improved diagnostic score. 

Biography

Wolf Eilenberg is a surgeon at the Department of Surgery at the Medical University Vienna. His research focus and expertise involves the role of neutrophils in carotid atherosclerotic disease and biomarkers of vulnerable carotid plaque. During the last few years, his primary interest was NGAL (Neutrophil gelatinase associated lipocalin), where he was able to show, that NGAL may identify the vulnerable plaque by a simple ELISA test in peripheral blood. For this work he was awarded the Finlandia prize 2016. Recently his field of interest widened towards the role of neutrophils in abdominal aortic aneurysm. Neutrophils, which were citrullinated may expulse their inside 
DNA, forming neutrophil extracellular traps (=NETs), which are associated with significant inflammatory processes in the abdominal aortic wall and intraluminal thrombus. He extended his experience by murine AAA models investigating possible treatment options in AAA by applying NET-inhibitors 

Abstract

Neutrophil extracellular traps (NETs) have been implicated in the pathogenesis of abdominal aortic aneurysms (AAAs). NET formation involves histone modifications such as citrullination allowing for DNA decondensation and DNA release into extracellular space. NETs have been detected in the adventitia and intraluminal thrombus (ILT) of AAAs and the associated proteins have been proposed to promote the inflammatory reaction that drives aneurysm development. Our study has addressed the notion that NET components might serve as AAA biomarkers or novel targets of AAA therapy. Parameters of neutrophil activation as well as NET formation were determined in blood and tissue samples collected from 40 AAA patients (scheduled for surgical repair) and 40 healthy controls matched for age, sex, body mass index and smoking habit. Neutrophil and NET components were determined by ELISA in patient plasma or conditioned medium of resected tissue. NETs were visualised in aortic wall and ILT by immunofluorescence microscopy. In a model of AAA formation based on angiotensin II administration to ApoE null mice, inhibition of NET formation was tested by applying a citrullination blocker. Among the tested parameters of neutrophil activation and NET formation, citrullinated histone H3 was found to be significantly increased in blood (median 362 vs. 309 ng/ml p=0.004) and aortic tissue (50.9 vs. 3.7 ng/mg p=0.001) of AAA patients compared to healthy controls. Furthermore, NETs were highly prevalent in the intraluminal thrombus (corresponding to 642.3 ng citrullinated histone H3 per mg ILT). Plasma levels of citrullinated histone H3 decreased significantly after surgical repair. In vivo application of a citrullination inhibitor significantly reduced the capacity of mouse neutrophils to undergo NET formation. Furthermore, when aneurysm formation was initiated by angiotensin II application, disease progression was prevented in mice treated with the NET inhibitor (N=5) as compared to controls (N=5; p=0.014). Histone citrullination which occurs during the 
formation of neutrophil extracellular traps was revealed as a biomarker of AAA formation and a potential therapeutic target to control aneurysm progression in established disease (as would be required for clinical application). 

Biography

Ihor Huk is the Chairman of Division of Vascular Surgery since 2013 and Director of Vascular Laboratory since 1994, Department of Surgery Medical  University Vienna. He completed his Post-graduate education from University of Chicago, Heidelberg. His expertise in Transplant Surgery: since 1984 - kidney, liver transplantations And Vascular Surgery: clinical, experimental research (SPACE-Study, L-arginine study), Carotid Study (Lancet 2010). His is a member of Austrian Society of Surgery, Austrian Society of Angiology, Austrian Society of Vascular Surgery, Ukrainian Academy of High Education, Ukrainian Academy of Sciences, Member of Senats - Zaporizhzhia Medical, Postgraduate Academy. He has been given Honorary titles of: Professor Honoris Causa Universities Medicinalis Leopoliensis No. 009, University of Lwiw, Ukraine und Med. Universitat in Ternopil, Ukraine. He has more than 320 Scientific publications in German, English and Ukrainian national and international. A comprehensive list of publications of journal articles provides an overview of Prof. Huk’s research activities. Concurrently, the expert in vascular surgery also gives many international lectures at the most distinguished vascular surgery and medical conferences. 

Abstract

Aim: We aimed to evaluate short and mid-term results of commercially available prefabricated vascular grafts made of bovine pericardium. Herein, we report on our institutional experience with the use of these grafts. Methods: Six patients underwent Aorto- Iliac repair with commercially available grafts made of bovine pericardium (BPG), in an additional patient a BPG was utilized for the management of an infected PTFE fem-pop bypass graft, for the management of graft infection or in the presence of systemic infection. Comorbidities, procedure related details, postoperative mortality and mid-term follow up were assessed and analyzed. The seven patients treated with BPGs form the base of this study.  Results: 71% (5) were male, mean age was 61.4±10.9 years. Comorbidities: arterial hypertension 100% (7), smoking 71% (5), coronary artery disease 43% (3), peripheral arterial disease 86% (6) and chronic renal disease 29% (2). Indications for surgery were: i) graft infection 71% (5), ii) arterial reconstruction in the presence of systemic infection 29% (2). Five patients (71%) had a history of previous vascular surgery. In 86%, polymicrobial cultures were available (6), amongst the isolated pathogens were Staph aureus, Pseudomonas aeruginosa and E. coli. For direct repair a bifurcated graft configuration was used in all aortic cases. Median follow-up: 107 days (max: seven months). Thirty-day mortality was 14% (1) – congestive heart failure – a patient operated successfully for an infected graft, undergoing surgery for control of infection prior to intended cardiac surgery, overall mortality was 14%. Conclusion: Our data support the conclusion that the use of BPGs represents an excellent conduit for the management of: i) aortic graft infections, ii) aortic reconstruction in the presence of systemic infection, and iii) infected prosthetic grafts utilized in peripheral arterial reconstructive surgery.
 

Biography

Tejas P Singh is a Resident Medical Officer at the Vascular Surgery Department of the Townsville Hospital and a Junior Research Fellow at the Queensland Centre for Peripheral Vascular Disease

Abstract

Aim: Indigenous Australians are at high risk of developing diabetes-related foot complications requiring major lower limb amputations. The aim of this study was to assess the incidence and outcome for Indigenous Australians and non-Indigenous Australians undergoing major amputations (MA) at the main tertiary hospital in North Queensland, Australia over a 16-year period. Methods: This was a retrospective study assessing all patients who underwent a MA at The Townsville Hospital between 2000 and 2015. Clinical characteristics were compared using Pearson’s χ2 test and Mann Whitney U test. MA rates (per 100,000) were calculated using the census data as the standard population. Kaplan Meier survival analysis and Cox proportional hazard analysis compared the incidence of all-cause mortality among both groups. Results: A total of 374 MA occurred between 2000 and 2015. Seventy MA occurred in Indigenous Australians and 304 occurred in non-Indigenous Australians. Indigenous patients were younger (p<0.005), more likely to be females (p=0.002), have diabetes (p<0.005), end-stage renal failure (p=0.003), and were more likely to die during follow-up (p=0.028). Overall rates of MA in Indigenous and non-Indigenous patients with diabetes were 291.9 and 70.1 per 100,000 respectively. MA rates increased in Indigenous (~15%) and non-Indigenous patients (~50%) with diabetes between 2000-2007 and 2008-2015 (p=0.505). Indigenous patients were at a ~2-fold greater risk of all-cause mortality (p=0.027) compared to non-Indigenous patients. This association was lost in the multivariate analysis (HR 1.24 [0.82-1.89], p=0.314). Conclusion: The burden of MA has increased in North Queensland and is greater in Indigenous Australians.
 

Biography

Haibo Lu has his expertise in wartime extremity vascular injury rescue, surgical treatment for senior hip fracture and bone-allograft scaffolded tissue engineering. Most of his innovations are derived from clinic problems and factual demands from combat environment. His contexture innovation of vascular shunt might be a novel attempt to vascular repairing 

Abstract

Statement of the Problem: To reduce the ischemia time of injured limbs in wartime, temporary vascular shunts (TVS) are commonly used. However, TVS are stabilized at the ends of the injured vessels using manual suture ties, the risk of dislodgement is high, and tightening manual suture ties is too time consuming. Methodology & Theoretical Orientation: Locked temporary vascular shunts (LTVS) were designed, and each was composed of a silicone tube with a threaded outer surface and smooth inner surface in addition to two nylon buckle switches. The buckle switches were used to stabilize the silicone tube of the LTVS with respect to the vessel walls. This job was performed with two manual suture ties with the current TVS. Findings: The mean bursting pressure value of the veins shunted with the LTVS was 114.3% higher than that of the veins shunted with the TVS (0.045±0.008 MPa vs. 0.021±0.012 MPa; p=.00). Although the mean shunting time of the LTVS was reduced by 60.4% compared with that of the TVS (138.89±18.22 seconds vs. 350.48±52.20 seconds; p=.00), there was no significant difference in the patency times between the two types of devices (8.20±9.01 hour vs. 8.40±8.85 hour; p=.98). Conclusion & Significance: The LTVS, which was designed to treat wartime vascular injuries, might be safer and more efficient than the current TVS.
 

Biography

Huang Kai is the expert in the surgery of peripheral vascular surgery and thyroid surgery. Chen Qinchang, Male, born in January 1995, student of Dr Huang Kai, has been studying in Clinical Medicine Major of Zhongshan School of Medicine in Sun Yat-sen University from August 2013. Without any unexpected accident, he will be awarded the bachelor’s Degree in medicine. Though he is the undergraduate at Grade 5, he has been the expert at data mining, gene chip analysis and clinical research 

Abstract

Statement of the Problem: More than 200 million patients have periphery artery disease (PAD) worldwide and the number of asymptomatic PAD patients were several times larger than that in the symptomatic PAD patients. Without obvious clinical symptoms, asymptomatic PAD have the similar risk of cardiovascular mortality and the mortality is much higher than the health. Though the asymptomatic PAD was observed with high morbidity and great hazard, sufficient attention has not been paid. We aimed to systematically appraise the guidelines on the screening and treatment of asymptomatic PAD and find out the agreements and the different in the recommendations. Methodology & Theoretical Orientation: Clinical guidelines and consensus statements in English to November 2017 were searched using MEDLINE, EMBASE and some websites of guideline organizations. Three reviewers appraised the quality of the included guidelines by using AGREE II instrument. The recommendations were also fully extracted and compared. Findings: Of 3245 citations identified, 14 guidelines were included. The AGREE score ranged from 35ï¼… to 75ï¼… , mainly due to poor quality in “rigour of development” domain and “. Editorial Independence” domain. For screening, 10 guidelines contained the recommendations, among which, 8 supported, one opposed and one guidelines considered insufficient evidence. For the treatment, most area was blank and the controversy was in the use of antiplatelet therapy. The guidelines with financial relationships with pharmaceutical industry or without clear statement for conflicts of interest, seemed to be more aggressive in the screening or treatment. Conclusion & Significance: The quality of most guidelines for the management of asymptomatic PAD should be improved. More clinical studies with high quality are needed to provide the clear-cut evidence to answer the controversy and the clear statement for conflicts of interest should be provided.
 

Biography

Sanjay Singh has his expertise and passion in Vascular and Endovascular Surgery. He has done complex aortic endovascular fellowship and is a Vascular Consultant working in United Kingdom. His open and contextual surgical techniques are based on researched and practiced models which helped to create new pathways for innovation. He has achieved this aptitude after years of experience in research and teaching in university hospitals and institutions. The ever-responsive and adapting field of Endovascular Surgery has improved the survival rates of high risk patients 

Abstract

Introduction: Duplex scanning is currently the best method to detect stenotic lesions that threaten bypass graft patency. The correction of these lesions may improve long term patency of grafts and limb salvage rates. The aim of this study is to investigate the effects of duplex surveillance post femoro-popliteal bypass graft for chronic limb threatening ischemia (CLTI) in terms of graft patency and limb salvage. Methodology: A retrospective analysis of 59 patients who had underwent femoro-popliteal bypass graft for CLTI between Jan 2009 and April 2014. Data was collected from the electronic computer record and analyzed using SPSS v24. Results: Of 59 patients; 49 (83.1%) had autologous vein graft, 8 (13.6%) prosthetic vein grafts and 2 (3.4%) composite graft. Mean follow up was 13.6 (0-64) months. Mean age was 77 (58-96) years. Duplex scan surveillance was performed in 35 (71.4%) patients at 3, 6, 9, 18 and 24 months post operatively; 27 in autologous vein, 7 in prosthetic graft and 1 in composite. Positive findings of occluded graft were noted in 10 duplex scans; all blocked grafts were autologous vein grafts. Out of the 17 patent vein grafts, stenosis was noted in 9 veins requiring angioplasty. Two patients needed amputation after angioplasty. Primary patency at 1 and 2 yrs. for duplex surveillance group was 71.4% and no surveillance group was 54.2%. Within two years 21 patients needed major amputation. Total amputation rate was 35.5%. Ten amputations in patient who were on surveillance were 28.5% and eleven who had no surveillance were 45.8%. At 7 years amputation free survival (AFS) was 48.6% vs. 16.7% in no surveillance group (HR 0.52 95% CI 0.28-0.99 p=0.047); Limb salvage was 71.4% vs. 54.2% (HR 0.57 95% CI 0.24-1.35 p=0.203) and overall survival was 71.4% vs. 33.3% (HR 0.37 95% CI 0.168–0.817 p=0.14). Conclusion: In our cohort the important clinical outcomes following bypass surgery for chronic limb threatening ischemia are far better if patients were enrolled in a local graft surveillance protocol.
 

Biography

Lingyun Jia, associate professor of the Department of Vascular Ultrasonography, Xuanwu Hospital, the Capital Medical University, has excellent expertise in carotid artery ultrasound, transcranial color-coded sonography (TCCS) and transcranial Doppler (TCD). Her research focuses on the following areas: 1) Systemical evaluation of the vessel structures and hemodynamics in intracranial artery and extracranial artery by multiple-modes of ultrasound in patients with ischemic cerebrovascular diseases. 2) Evaluation of the vessel structures and hemodynamic alterations before and after carotid artery stenting and carotid endarterectomy. 3) Evaluation of internal jugular veins abnormalities by ultrasound 

Abstract

Objective: To study the relevance between the incidence of residual stenosis and carotid artery stent (CAS) characteristics by color duplex flow imaging (CDFI). Methods: Five hundred and seventy two cases (576 stents, open or closed-cell stents) who underwent CAS from January 2013 to December 2015 were retrospectively enrolled in this study. The location of carotid stenosis (common carotid artery or internal carotid artery), characteristics of plaques (regular morphology or not; with calcification or not), the length of stent, types of carotid stent (closed or open cell), rate of stent expansion (ratio of radial expansion and axial expansion) were detected one month before and one week after stenting by CDFI. Residual stenosis is defined as the stenosis rate is equal to or greater than 30% by DSA immediately after stenting. Results: All of 576 stents, the incidence of residual stenosis was significantly higher in group of closed loop stent (28.3%, 46/163) than in group of open loop stent (20.4%, 84/413) (ï¼…2=4.15, P=0.04). There were positive correlation between the occurrence rate of residual stenosis and closed-cell stent (odd ratios, 1.54; 95% confidence interval, 1.02-2.23) and negative correlation with the radial expansion rate (odd ratios, 0.02; 95% confidence interval, 0.01-0.06). The location of carotid stenosis and the lengths of stents were not affecting the incidence of residual stenosis. Irregularly shaped plaques (odd ratios, 9.72; 95% confidence interval, 5.65-16.76) and the plaques with calcification (odd ratios, 5.21; 95% confidence interval, 3.32-8.17) were the independent risk factors of residual stenosis after CAS. Conclusions: This study suggests that choosing a more adaptable stent based on the types of stents and the characteristics of plaques and trying to increase the radial expansion of stenting may further decrease incidence rates of residual stenosis.
 

Biography

Degree in Medicine and Surgery, University of Milan and Specialist in Vascular Surgery. Assistant Professor in Vascular Surgery at the University of Milan since 1994  Field of interest: He is experienced in the diagnosis and treatment of all the aspects of vascular pathologies (in particular for carotid surgery, endovascular treatment of abdominal aortic aneurysm and varicose veins surgery). Author of numerous publication, he collaborates with Politecnico of Milan and Ecole Politechnique Federale de Lausanne for the development of bioengineering methods of analysis of Computational Fluid Dynamics (CFD) in vascular pathologies. He is the co-founder and designer of aXurge, a startup dedicated to AAA endovascular treatment (www.aXurge.com).For these researches, he received grants from MIUR in 2005 and ERC in 2015. 

Abstract

BACKGROUND: Aortic Abdominal Aneurysm (AAA) management requires to deal with different tasks: clinical evaluation, analysis and forecast risk of rupture, analysis of radiological imaging, evaluation of the feasibility for endovascular repair (EVAR), sizing and planning. OBJECTIVE: aXurge© is the ultimate web platform for the treatment of AAA. Combining advanced mathematical techniques in the fields of imaging, numerical and statistical analysis, aXurge© provides an advanced valuable tool for: • Vascular specialists, as it assists them during every step of the decision procedure: from the analysis of the DICOM images to an insightful and aware assessment of the patient condition, and the planning for EVAR configuration of the surgical operation. • EVAR manufacturers, as it offers a dedicated space to interact with vascular specialists and to access a rich statistical database that will be continuously updated with new clinical cases. MATERIAL AND METHODS: aXurge© web-platform provides the following features: • Private case history database. • Image processing and sizing. Our application guides clinicians to obtain from medical imaging AAA sizing and morphological characterization. • Statistical classification and enhanced morphological and biomechanical assessment in order to produce a statistical classification of AAA.
RESULTS: Over a training set of 283 geometries, after the manual selection of solely 5 seed points, our algorithms are actually able to automatically perform AAA’s sizing in the 79% of the cases. CONCLUSIONS: The great value of aXurge© relies in the synergy of several individual high-level skills, needed to achieve an effective product. aXurge© aims not only at bringing innovation to vascular experts but also at interacting and collaborating with them to ensure continuous improvement in patients’ healthcare.
 

 

Biography

Shannon Hernon is currently an exercise specialist and PhD researcher at the National University of Ireland Galway. Her expertise roots from an education in exercise and sport science and has expanded to personal training and exercise intervention for special populations. Shannon’s at home full body resistance exercises programmes has allowed a new approach to management of intermittent claudication. She is currently working on a project comparing at home resistance exercise to supervised walking to determine if both programmes will elicit similar psychological and physiological benefits for moderate intermittent claudication 

Abstract

Statement of the Problem: Walking is the recommended mode of exercise for moderate intermittent claudication (IC). There is currently limited information on the effect of remote ischemic preconditioning (RIPC) and structured resistance exercise (SE), specifically full-body exercise using resistance bands, for improving walking ability. The purpose of this study is to determine if an at home structured resistance exercise programme would elicit similar improvements in walking ability, body strength endurance and quality of life (QOL) in individuals with moderate IC compared to a combination intervention of RIPC and at home structured resistance exercise. Methodology & Theoretical Orientation: As a pilot study participant were recruited from the vascular clinic over a 52-weeks and randomly allocated to one of two interventions: a 12-week RIPC and at home SE programme (RIPCS+SE) or a 12-week at home SE programme alone. Walking abilities and body strength endurance were assessed at baseline, 6-weeks and 12-weeks. QOL was assessed using EQ-5D-3L questionnaire. Findings: Thirty-one participants were recruited, 25 males and 6 females, whereby 15 were randomized to the 12-week RIPC+SE and 16 to the 12-week at home SE programme. Seven participants completed 6-weeks and 3 completed 12-weeks of the at home SE programme. Eight participants completed 6 weeks and 3 completed 12-weeks of the RIPC+SE programme. The median pain-free walking distance (PFWD) at baseline was 139.92m in the RIPC+SE group and 137.515m in the SE group. At 12 weeks the median PFWD was 316.625m and 294.5m in the RIPC+SE and the SE groups respectively. QOL scores were similar in both groups. Conclusion & Significance: Both interventions achieved significant improvements in PFWD. An at home SE programme, facilitates patient autonomy on timing and place of treatment, may be an effective intervention for patients with moderate IC. Further studies are required to determine the efficacy of this intervention. 

Biography

Oscar Ojeda is an Ecuadorian vascular surgeon specialized in Argentina. He performed a fellowship in endovascular surgery at Albany Medical Center, USA, and has completed observerships in the most important hospitals in the world (Cleveland Clnic, Mayo Clinic, New York University). In 2016 he received an award from the SVS (International Scholar) and is currently part of the department of vascular surgery of the largest public hospital in Ecuador, the Eugenio Espejo Hospital 

Abstract

INTRODUCTION: The carotid body tumors belong to the paragangliomas group whose cellular origin is the neuroendocrin extra-adrenal system. The chronic hypoxia is one of the causes. Their diagnosis is based on the clinical presentation and in an image study like ultrasonography, angioCT, angio MR and angiography, this last one at the moment is not of common use and it has been displaced by other techniques. We propose a new classification. PATIENTS: Sixty-nine patients have been analyzed with diagnostic of carotid body tumor, all with unilateral in a 10-year-old period (2007-2017). Twelve men and 57 women. Mean age: 62 years (30-75). Forty of the left side and twenty-nine of right side. The most common form of presentation was an asymptomatic cervical mass. Most of the patients come from the region bigger mountain of cities to 2000 msnm. The diagnosis for more used image was the ultrasonography and the angioCT, in seven cases was not carried out image study. Preoperative embolization with cyanoacrylate and Onyx has been used in tumors bigger than 3 cm prior to surgery. Sixty-eight cases were subjected to surgery and in a case it was not possible the resection for discoveries of malignancy. In all the operated patients the subadventicial technique was used. Thirtyfive patients were classified in tumor type Shamblin I, 21 of type II and 13 of type III. Complications in 12 cases, eight of the type III and four of the type II of Shamblin and they include: tear of the carotid bifurcation, longitudinal angioplasty of the internal carotid and ligation of the external carotid.  Postoperative morbility was presented in 15 cases: disphonia, haematoma of surgical wound and asymmetry of the tongue. There was not mortality. CONCLUSIONS: Ecuador is a country with high prevalencia and incidence of carotid body tumors and this could be justified for the numerous cities that are on the 2000 meters on the level of the sea. The surgical procedure should be carried out by a surgeon with wide experience in technical of carotid reconstruction and handling of vascular and nervous package of neck, for this way to diminish the patient’s morbility and mortality. The embolization should be used in tumors bigger than 3 cm to disminish the risk of bleeding.
 

Biography

Luboš Kubíček received his MD degree from Faculty of Medicine, Masaryk University in Brno (Czech Republic) in 2011. He is a fifth-year postgraduate student in vascular surgery, university teacher, clinical researcher and vascular surgeon at 2nd Department of Surgery of St. Anne’s university hospital in Brno, Czech Republic. His main research interests are: rupture risk prediction of abdominal aortic aneurysms, thermographic imaging in vascular surgery, systemic enzyme therapy in chronic wound healing and he is also involved in several international clinical trials, both drug research and interventional trials. He is also author or co-author of several grant project proposals and in this time, he is involved in two research grant projects. 

Abstract

Objective: Angioplasty often results in dissections and remains a significant problem. Dissections are typically managed with stents, which are associated with high rates of in-stent restenosis. Two tack optimized balloon angioplasty (TOBA) studies evaluated the safety and efficacy of a novel implant for dissection repair in both above and below the knee lesions. The Tack combines low outward force with minimal metal to provide focal treatment for dissections. Methods: TOBA was a prospective, single-arm study evaluated patients with Rutherford Category 2-4 caused by lesions of the superficial femoral and popliteal arteries. Patients were treated with standard balloon angioplasty, and post-PTA dissections were treated with Tacks. The primary endpoints were device technical success (ability of the Tack implants to resolve postPTA dissection) and device safety (absence of new-onset major adverse events). TOBA BTK, a separate study, evaluated patients with CLI and infrapopliteal lesions. The primary safety endpoint was a composite of MALE and POD at 30 days. Device success and procedure success were also assessed. Results: In TOBA, Tacks were used in 130 patients with post-PTA dissections (74.0% grade C). Technical success was achieved in 98.5% of patients with no major adverse events at 30 days. Twelve-month patency was 76.4%, and freedom from TLR was 89.5%. Significant improvement from baseline was observed in Rutherford clinical category and ankle-brachial index at 12 months (p<0.0001). In TOBA BTK, 32 patients received dissection repair with Tacks. Freedom from MALE and POD at 30 days was 97.1%. Twelve-month patency was 78.4% and freedom from CD-TLR at 12 months was 93.5%. Conclusions: Tack implant treatment of post-PTA dissection was safe and resulted in low rates of TLR both above and below the knee. Tack treatment represents a new, minimal metal paradigm for dissection repair that can safely improve the clinical results associated with PTA.
 

Day2: May 25, 2018

Keynote Forum

Biography

Ihor Huk is the Chairman of Division of Vascular Surgery since 2013 and Director of Vascular Laboratory since 1994, Department of Surgery Medical University Vienna. He completed his Post-graduate education from University of Chicago, Heidelberg. His expertise in Transplant Surgery: since 1984 - kidney, liver transplantations And Vascular Surgery: clinical, experimental research (SPACE-Study, L-arginine study), Carotid Study (Lancet 2010). His is a member of Austrian Society of Surgery, Austrian Society of Angiology, Austrian Society of Vascular Surgery, Ukrainian Academy of High Education, Ukrainian Academy of Sciences, Member of Senats - Zaporizhzhia Medical, Postgraduate Academy. He has been given Honorary titles of: Professor Honoris Causa Universities Medicinalis Leopoliensis No. 009, University of Lwiw, Ukraine und Med. Universitat in Ternopil, Ukraine. He has more than 320 Scientific publications in German, English and Ukrainian national and international. A comprehensive list of publications of journal articles provides an overview of Prof. Huk’s research activities. Concurrently, the expert in vascular surgery also gives many international lectures at the most distinguished vascular surgery and medical conferences.

Abstract

Through the eyes of biochemist, the body is composed of elements. The biological function of a number of essential elements will be discussed. Carbon-based life depends on two important molecules: oxygen and nitric oxide. Both have been known for more than 200 years, but their biological function was only elucidated at the end of the 20th century. Which of these mole-cules is the more important for the brain, heart and vessels, and the immune system will be examined. The importance of the amino acid arginine and its presence in foodstuffs will be explained. The influence of some important co-factors controlling the synthesis of nitric oxide from arginine will be presented. Finally, some clinical data relating to vascular and neurologi-cal degenerative diseases will be given. The importance of 25OH vitamin D (D3) as an inde-pendent risk factor in developing above-mentioned pathologies is soon to be confirmed in sci-entific publications. The second part of the presentation will deal with the elemental/chemical composition of the human body itself, with some new data given on the effect of elemental deficiencies. Some practical recommendations will be given for every-day life in support of basic cellular function.

Biography

Prof. Christoph Neumayer is the interim head of the division of Vascular Surgery, Department of Surgery, Medical University Vienna. His main research focus inherits carotid atherosclerosis and the abdominal aortic aneurysm, especially basic research models of AAA in mice and novel therapy options.
 

Abstract

Neutrophil extracellular cells have emerged to be more important in their role of inflammatory responses than phagocytic actions. Recent publications showed neutrophils to be involved in the activation of the IL-1 family and subsequent distribution of neutrophil proteases to the inflammatory site. The abdominal aortic aneurysm (AAA) is considered a chronic inflammatory disease with neutrophils recruited to the aneurysm site and intraluminal thombus, releasing neutrophil proteases and reactive oxygen species, which contribute to media destruction.  D-Dimer and myeloperoxidase, distinctive neutrophil proteases have evolved as potential sensitive AAA markers, supporting the hypothesis of neutrophils to be key players in AAA pathogenesis.    During the recruitment of neutrophils to the aneurysm site and intraluminal thrombus, activated neutrophils may undergo the process of NETosis, which involves histone modification by citrullination, allowing the DNA to be condensated and subsequent DNA and sticky traps release into the extracellular space. These NETs are recently discussed to be a potential biomarker in AAA pathogenesis. NETs were found in AAA mouse model and its inhibition prevented AAA development. Furthermore, anti-inflammatory treatment such as metformin in diabetic patients was associated with reduced AAA growth. The potential therapeutic approach of metformin in systemic lupus erythematodous could already be elucidated by reduced inflammatory skin flares through reduced NET formation. In summary, neutrophils, neutrophil proteases and NETs are intensively discussed as potential biomarkers in AAA, this lecture will give an overview of all recent findings on neutrophils and their products in AAA. 

Tracks

  • Endovascular Surgery | Carotid Artery Diseases | Venous Surgery | Vascular Imaging | Vascular Bypass Grafting
Location: Johnson
Speaker

Ihor Huk

Medical University Vienna, Austria

Chair

Biography

Martin Funovics is an interventional radiologist and has been working in all fields of endovascular treatment and oncologic IR for over 20 years. He has authored over 90 peer-reviewed publications both in clinical IR as well as in basic research in vascular and tumor biology. He has co-developed novel stent graft designs for aortic repair and performed several first-in-man procedures of novel devices. He is PI of the first (ongoing) RCT assessing chronic outward force between different nitinol stents in peripheral arterial disease. 

Abstract

BACKGROUND: The endovascular treatment of peripheral arterial occlusive disease (PAOD) has undergone rapid evolution during the last years, characterized by the availability of a plethora of new devices and techniques that make an increasing number of lesions (technically) amenable to an “endo-first” approach. The interventionalist is now confronted with a multitude od options to cross and treat a lesion, but surprisingly little scientific evidence exists as to which method should be preferred over another, and in which lesion. For example, the notion that primary nitinol stents are superior to balloon angioplasty is based solely on three RCTs, the superiority of drug eluting stent over bare stent on a subgroup in one RCT, and the difference between drug-eluting balloons and nitinol stenting has never been addressed in an RCT. LEARNING OBJECTIVES: This course will provide an overview of available endovascular techniques, including balloon angioplasty, bare stent implantation, stentgrafts, drug-eluting balloons, and drug-eluting stents. Region by region, the available literature concerning experience, expected primary patencies, and comparisons (where available) between the available methods will be appraised. Questions for which evidence is urgently needed but not available will be defined. For each region, a decision tree based upon the available evidence will be drafted and opened for discussion. The following techniques will be covered: • Balloon angioplasty • Bare nitinol stents • Drug-eluting stents • Sentgrafts • Drug-eluting balloons

Biography

Ahmet Akgul has graduated from Ankara University Medical School in 1997. He had completed his Postdoctoral residence and fellowship in the Michael E DeBakey Department of Surgery at Baylor College of Medicine in Houston, Texas. In 2004 in addition to his Chief Assistant position, he also served as an Editor in Turkiye Klinikleri Journal of Medical Sciences. In 2009 he was charged with establishing Heart and Vascular Surgery clinic at Istanbul Bakirkoy Dr. Sadi Konuk Hospital where he performed his works as founding clinic chief. Due to the increasing aging population in Turkey and this senior group being the majority of the heart and vascular diseases patients, he has established the Department of Gerontology in Istanbul University. In doing so he had received his Professorship and the title of Founding Department Head. 

Abstract

Statement of the Problem: Chronic post-thrombotic syndrome (CPTS) refers to chronic clinical manifestations of venous insufficiency after deep venous thrombosis.  CPTS is the most important consequence of CDVT, which develops in 20% to 50% of patients after proximal CDVT (popliteal and above CDVT) despite optimal anticoagulation therapy. Methodology & Theoretical Orientation: We report the successful percutaneous management of extensive lower-extremity deep venous thrombosis (DVT) in 70 lower limbs (68 of them acute/ subacute DVT and 2 CDVT) of consecutive 69 patients using pharmaco-mechanical thrombectomy. A 14F introducer sheath was inserted through the popliteal vein followed by rotational and aspiration thrombectomy. Balloon angioplasty was performed when needed. No stent insertion was added. Routine percutaneous pharmaco-mechanical treatment was performed in acute and/or subacute DVT and atherectomy with pharmacologic treatment were performed in CDVT. Findings: From 2014 to 2017, single-session percutaneous endovenous pharmaco-mechanic thrombectomy was performed in 70 lower limbs of 69 patients (42 men; mean age: 41.8 years) with DVT. DVT was in subacute forms in 20 patients, and in chronic (1 patient with two limbs). Technical success rate was 97.1% (68 of 70 limbs). Among the 68 limbs, thrombectomy alone was performed in 62 (91.1%) limbs; additional balloon angioplasty of the femoral vein was performed in 6 patients. One patient with two limbs (chronic DVT) was performed thrombectomy with arterial atherectomy device with aspiration as well as balloon angioplasty. Conclusion & Significance: Percutaneous endovenous thrombectomy is feasible and effective for patients with acute and subacute deep vein thrombosis. More patients with chronic DVT could be treated by revised-atherectomy device in the near future. 

Biography

Hussien Rabee, MBBch, MSc,FRCS, PHD. Consultant Vascular Surgery in Countess of Chester Hospital (2015-2018). Associate Professor & Consultant Vascular Surgery, College of Medicine, Riyadh, Saudi Arabia (1998-2014). Founder of Vascular Surgery Training Program, Head of Vascular Surgery unit & Animal Lab. Author and Co-author in different researches in Vascular Surgery. 

Abstract

Statement of the Problem: Intermittent claudication is not a common presentation in young people as they are rarely suffering from chronic lower limb ischemia. Popliteal artery entrapment syndrome (PAES) is one of the main known causes of intermittent claudication and should be considered among this young age group. Most of the reported cases are males and usually present before the age of 45. Different anatomical variations found to explain the abnormal compression on the artery in the popliteal fossa. These include variant medial head of gastrocnemius muscle, muscular slip, popliteus muscle or plantaris muscle as a constricting agent. It can be bilateral up to 34% of cases. Repeated trauma may damage the popliteal artery and lead to stenosis, thrombotic occlusion or post stenotic aneurysmal dilatation. Lack of awareness could lead to delay in diagnosis and complications. Methodology: The data of this study has been retrospectively collected with review of patients undergoing operative treatment of popliteal artery entrapment syndrome (PAES). Eight patients (11 limbs) presented, diagnosed and surgically treated. All of them were males. Six limbs had PAES on the left side. The age ranged from 21 to 47 years with median age of 31 years. Only one patient was diabetic and two were smokers. Out of the 11 limbs included in our study, three patients had bilateral PAES with unilateral symptoms. The mean duration of symptoms was 12 months and ranged between 3 and 24 months. Conclusion & Significance: Diagnosing PAES is mainly based on clinical assessment with support of duplex scanning; ankle brachial index (ABI) drop during muscular stress is a good predictor to identify patients benefit from surgical decompression and keeping high threshold to offer surgery for PAES will save patients from inadequate outcome. 

Biography

Sin Daw Lin performs endoscopic face lifting for facial rejuvenation and expands the endoscopic surgery to manage the benign tumor of the head and neck. He also manages the varicose veins with the assistance of endoscopic surgery to decrease the recurrence rate. He performed immediate breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap in over 1230 cases since 1997. Recently, his research team, have established a core laboratory for the study of human adipose derived stem cells (hADSCs). They have developed a new culture medium for rapid proliferation of hADSCs and can harvest a large number of stem cells within a short period. 
By tissue engineering, they have succeeded the production of new adipose tissue from hADSCs in immune-deficient mice. He expects in the near future they can reconstruct soft tissue defect with autologous adipose tissue by tissue engineering.

Abstract

Aim: The recurrence rate of management of varicose veins was high and ranged 20–60% in previous reports. In this study, primary varicose veins were managed through endoscopic assisted surgery. The recurrence rate and satisfaction rate were evaluated. Materials & Methods: From 1997 to 2017, 1966 limbs of primary varicose veins and its complications were managed through endoscopic assisted surgery. With good illumination and magnified view offered by the endoscopy, tissues in the operative field were visualized clearly. The varicose main trunk and its tributaries, incompetent perforating veins, non-varicose veins and saphenous nerve could be identified by their anatomic appearance. The features of varicose veins explored include: 1) poor contractility of varicose veins; 2) dilated, tortous and flaccid changes of varicose veins and 3) saccular or lateral buldging deformities of vein wall. The anatomic abnormalities were supernumerary tributaries along the main trunk, varicose clusters formed by main trunk, tributaries and/or incompetent perforating vein; variable size and location of incompetent perforating veins. The complicated abnormality of these varicose veins could be carefully dissected and radically excised. The operation procedures will be demonstrated in a video. Because all the abnormal varicose veins and incompetent perforating veins radically excised, and the recurrence rate marked is decreased. Results: The recurrence rate ranged from 0 to 2.3% in our serial reports. The satisfaction rate of 689 patients (2004-2013) was 96.5%. Conclusion: In management of primary varicose vein, endoscopic assisted surgery could achieve a low recurrence rate and high satisfaction rate. 

Biography

Ruediger Schernthaner is an expert in cardiovascular imaging. He has been developing CT angiography reformation techniques in collaboration with the Technical University of Vienna and the Stanford Medical Center for more than 10 years. He has published more than 50 peer-reviewed publications in the field of cardiovascular imaging and interventional oncology and authored the chapter “Management of Peripheral Arterial Disease” in the book “Managing Cardiovascular Complications in Diabetes”. 

Abstract

BACKGROUND: PAOD is a clinical diagnosis, the clinical Rutherford classification is based on walking impairment and the extent of ischemic ulceration. However, the complete delineation of the peripheral vascular tree is mandatory for treatment decision and planning according to the TASC guidelines (1). For long time, digital subtraction angiography was considered the gold standard due to its high temporal and spatial resolution. However, DSA is an invasive procedure requiring intra-arterial application of contrast agents, with an associated risk of complications (2) and the exposure of both patients and observers to ionizing radiation. Thus, MR angiography and CT angiography have been developed over the last 20 years in an effort to replace DSA for diagnostic purposes and to limit it’s application to therapeutic procedures. LEARNING OBJECTIVES: This course will provide you with an overview of MRA and CTA of the peripheral arteries with special emphasis on their capabilities and limitations as well as most recent technical developments (3-5). The following issues will be covered: • Volume coverage • Spatial resolution • Acquisition time • Accurate and fast image post-processing • Patient safety • Cost efficiency

Biography

Geng Long Hsu is a Clinical Professor at China Medical University. He has developed and refined a series of penile reconstructive surgeries, including penile venous surgery, corporoplasty and penile implantation, in tandem with advances in knowledge of the penile venous and tunical anatomy and of erection physiology. In 1993, he was promoted to the first Chair of Urology at Taiwan Adventist Hospital; he held that position until 1997 and then served as Vice-Superintendent of Po-Jen General Hospital until 2001. From 2001 to 2003, he was the Director of Microsurgery Potency Reconstruction at Taipei Medical University Hospital. Afterward, he has established his private practice—Hsu’s Andrology which serves as both a clinical practice and research center. In 2012, his latest method of penile venous stripping surgery, administered via local anesthesia on an ambulatory basis, was granted a USPTO patent. He hopes this surgery will be studied and practiced worldwide. 

Abstract

Disclosed is the latest method of a physiologically penile venous stripping for patients with erectile dysfunction (ED) secondary to veno-occlusive dysfunction (VOD), which mainly bases on a template of Hsu’s penile anatomy. It is further endorsed by Hsu’s erection physiology. Neither a Bovie nor a suction apparatus is required in the entire procedure. The method entails usage of a set of specific instrument used under an acupuncture-aided pure local anesthesia on an ambulatory basis. It includes a thorough penile venous stripping and then ligating one deep dorsal vein (DDV) and a paired of cavernosal veins (CVs) whereas two pairs of para-arterial veins (PAVs) are rendered for segmental ligation closest to the tunica albuginea. The Buck’s fascia is just made 5-6 opening on each emissary veins which drain the sinusoidal blood away from the corpora cavernosa. Thus the DDV trunk serves as a guide to strip the venous system along the penile shaft while the emissary vein is fixed by 6-0 nylon. A pull-through maneuver is made from opening to opening until the penile base. Likewise, the CVs are managed. A 3.5 cm long longitudinal wound is performed on the pubic region to relay the venous stripping procedure. As a rule, there are 6-9 and 5-8 branches require treated corresponding to DDV and CVs respectively from penile base to the penile hilum. A total of 67-132 ligation positions are required to complete the treatment of the offensive erection related veins. Both wounds are fashioned with layer by layer while an assistant stretch the penile shaft mimicking an erectile status. Although the techniques for handling venous tissues with stripping and then ligation is extraordinary challenging, this innovative method turns the venous treatment for ED resulting from VOD from one that has been abandoned to a curable option
 

Biography

Since 1986, Geng-Long Hsu, formerly a clinical professor at China Medical University, has developed and refined a series of penile reconstructive surgeries, including penile venous surgery, corporoplasty and penile implantation, in tandem with advanced the penile anatomy and erection physiology. In 1993, he was promoted to the first Chair of Urology at Taiwan Adventist Hospital; he held that position until 1997 and then served as vice-superintendent of PoJen General Hospital until 2001. From 2001 to 2003, Dr. Hsu was a director of microsurgery potency reconstruction at Taipei Medical University Hospital. Afterward, he established his private practice—Hsu’s Andrology—which serves as both a clinical practice and research center. In 2012, Dr. Hsu’s latest method of penile venous stripping, administered via an ambulatory basis, was granted a USPTO patent. He hopes this surgery will be studied and practiced worldwide. I, Chun-Kai Hsu, am pleasurable to conduct this report in fellowship. 

Abstract

A penile venous stripping has been effective for treating erectile dysfunction (ED) since 1986. We conduct a retrospective analysis to those who received the latest method of surgery on an ambulatory basis. From 2009 to 2016, 452 patients had a diagnosis of venoocclusive dysfunction (VOD). Of these, 283 men underwent the latest method of penile venous stripping. They were divided into young (n=46, younger than 30 years) and older (n=237) group respectively. The surgery begins with a circumferential incision followed by identification and management of the deep dorsal veins (DDV) 1.5~2.5 cm proximal to the retro coronal sulcus. It was then thoroughly stripped and ligated with 6-0 nylon sutures with a pull-through maneuver. The cavernosal veins (CVs) were managed in a similar manner. The para-arterial veins (PAVs) were only segmentally ligated. A median longitudinal pubic incision was then made to relay the stripping of the DDVs and CVs proximally to the infrapubic angle. Finally, the pubic and circumferential wounds were fashioned. A postoperative cavernosography was made immediately. The operative times were 4.1±0.7 and 4.0±0.6 hr. respectively. The follow-up period ranged 1.2~7.2 (5.3±1.2) years. Differences in erectile function were significant between the groups of young and older group in term of preoperative IIEF5 (n=33, 10.2±3.6 vs. n=212, 9.7±3.8) scores compared to either one-year postoperative (n=46, 19.1±3.2 vs. n=237, 16.4±3.0) ones or two years postoperative (21.3±1.7 vs. 18.2±3.2) respectively (both p<0.003). Overall, 92.3% (261/283) of the patients reported improvements. On the preoperative and postoperative cavernosograms, it was unexceptionally enhanced from weaker to stronger radiopacity by this penile venous stripping. This latest method of penile venous stripping appears to be a viable option which achieves favorable outcomes with negligible morbidity for treating ED secondary to VOD.
 

Biography

Since 1986, Geng-Long Hsu, formerly a clinical professor at China Medical University, has developed and refined a series of penile reconstructive surgeries, including penile venous surgery, corporoplasty and penile implantation, in tandem with advanced the penile anatomy and erection physiology. In 1993, he was promoted to the first Chair of Urology at Taiwan Adventist Hospital; he held that position until 1997 and then served as vice-superintendent of PoJen General Hospital until 2001. From 2001 to 2003, Dr. Hsu was a director of microsurgery potency reconstruction at Taipei Medical University Hospital. Afterward, he established his private practice—Hsu’s Andrology—which serves as both a clinical practice and research center. In 2012, Dr. Hsu’s latest method of penile venous stripping, administered via an ambulatory basis, was granted a USPTO patent. He hopes this surgery will be studied and practiced worldwide. I, Yi-Wei Pai, am pleasurable to conduct this report in fellowship. 

Abstract

Although penile implantation remains a final solution for patients with refractory impotence in many urologists, undesirable postoperative effects, including the development of pale appearance, size reduction and cold sensation of the glans penis in particularly the penile size itself, remain problematic. We sought to report an innovative surgical method designed to avoid these problems. From 2003 to 2017, 103 consecutive patients received a malleable penile implant. Of these 68 men (the enhancing group, after 2008) were also treated with venous ligation of the retrocoronal venous plexus, deep dorsal vein, and cavernosal veins in addition to standard penile implant. The remaining 35 men formed the control group, treated with only a penile implant. Follow-up ranged from 0.5 to 14.5 (8.7±1.0) years. Although preoperative glanular dimension did not differ significantly between the two groups, significant respective difference at one day and one year postoperatively was found in the glanular circumference (128.6±6.8 mm versus 115.5±7.1 mm and 131.6±7.2 mm versus 100.3±7.3 mm; both ï¼…<0.05), radius (38.9±2.7 mm versus 37.0±2.8 mm and 41.7±2.6 mm versus 33.7±2.9 mm; latter ï¼…<0.01), and satisfaction rate (95.8% versus 53.2%, ï¼…<0.01) as well. Inconclusive analysis of the penile copulatory portion ensued resulting from difficulty in practical measurement on this portion. Based on our results, selective venous ligation of penile erection related veins appears to enhance the glans penis dimension and probable the penile copulatory portion in implant patients: 

Biography

Tejas P Singh is a Resident Medical Officer at the Vascular Surgery Department of the Townsville Hospital and a Junior Research Fellow at the Queensland Centre for Peripheral Vascular Disease. 

Abstract

Aim: The risk factors for peripheral artery disease (PAD) are more common in Indigenous than non-Indigenous Australians. However, the presentation and outcome of PAD in Indigenous Australians has not been previously investigated. The aim of this prospective cohort study was to compare the presenting characteristics and clinical outcome of Indigenous and non-Indigenous Australians with PAD. Methods: PAD patients were prospectively recruited since 2003 from an outpatient vascular clinic in Townsville, Australia. Presenting symptoms and risk factors in Indigenous and nonIndigenous patients were compared using Pearson’s χ2 test and Mann Whitney U test. Kaplan Meier survival analysis and Cox proportional hazard analysis compared the incidence of myocardial infarction (MI), stroke or death (major cardiovascular events) among Indigenous and non-Indigenous patients. Results: 401 PAD patients were recruited, of which 16 were Indigenous and 385 were non-Indigenous Australians. Indigenous Australians were younger at entry (median age 63.3 [54.767.8] vs. 69.6 [63.3-75.4]), more commonly current smokers (56.3% vs. 31.4%), and more frequently had insulin treated diabetes (18.8% vs. 5.2%). During a median follow-up of 2.5 years, five and 45 combined events (MI, stroke or death) were recorded amongst Indigenous and non-Indigenous Australians, respectively. Indigenous Australians were at a 4-fold greater risk of major cardiovascular events (adjusted hazard ratio 4.03 [95% confidence intervals 1.17-13.87], p=0.027) compared to nonIndigenous Australians.    Conclusions: These findings suggest that Indigenous Australians 
with PAD present at a younger age have higher rates of smoking and insulin-treated diabetes, and poorer clinical outcomes compared to non-Indigenous Australians 

Biography

Aleksandra Piechota Polanczyk is currently employed as an Associate Professor at the Department of Medical Biotechnology, at the Jagiellonian University in the frame of the project entitled: Role of heme oxygenase 1 in the development and progression of abdominal aortic aneurysm. She received her PhD in Medicine with specialty of Medical Biology in 2011. She was a leading Researcher in Prof. Ihor Huk research group (VASLAB) at the Medical University of Vienna (Austria) with whom she is now cooperating. She is an author and a co-author of 37 publications published in Polish and foreign international journals (28 original papers and 8 review articles). Her research interests focuses on finding of new anti-oxidative and anti-inflammatory proteins that could be potential markers and/or targets in treatment of gastrointestinal and cardiovascular diseases, as well as the role of Nrf2 and heme oxygenase 1 in cellular adaptation to oxidative stress and inflammatory reactions 

Abstract

Introduction: This study was undertaken to verify if simvastatin modulates Cav-1/eNOS expression and if this modulation is associated with changes in pro- and anti-inflammatory cytokines and Toll-like receptor 4 (TLR4) in abdominal aortic aneurysm (AAA). Methods: This was undertaken on non-statin (n=12) and simvastatin-treated patients (n=24) who underwent open AAA repair. Patients were treated with simvastatin at a dose of 20 or 40 mg/day for at least 6 months. The tissue samples of AAA wall were analyzed for Cav-1, eNOS, interleukin 6 (IL-6), IL-10, IL-17 and TLR4 at the gene and protein level. Results: Simvastatin treatment significantly and dosedependently decreased Cav-1 and increased eNOS expression in AAA wall (p<0.05 and p<0.01, respectively). The changes in Cav-1 and eNOS were associated with increased concentration of IL-10 (p=0.055) but not IL-6, IL-17 or TLR4 expression in AAA wall. Conclusions: Simvastatin may modulate Cav-1 and eNOS expression in aneurysmal wall indicating a new beneficial role of statins in AAA patients 

Biography

Chi Can Huynh graduated from Sydney University in 1999. During his senior years in Medical School he completed a Surgical Research Term with Tom DeMeester at the University of Southern California. He was accepted into 
the Advanced General Surgical training scheme in 2003 and then onto the Advanced Urology Training Program in 2005. He was the inaugural Robotic Fellow at St. Vincent’s Prostate Cancer Centre in 2008. Following this, he spent 18 months in Manchester (United Kingdom) completing a laparoscopic prostate fellowship. He has interests in erectile restorative surgery and robotic prostate surgery and was the first in Australia to perform a robotic assisted radical nephro-ureterectomy and penile erection restorative vein surgery. His research interests are in erectile dysfunction and he is a part time fellow in erectile restorative surgery overseas. He co-authored papers in peer reviewed medical journals and presented multiple international conferences on the topic. He also holds teaching positions with the Rural Medical School of the Australian National University and the Australian School of Advanced Medicine. 

Abstract

Is coil embolization effective and safe to treat impotence resulting from veno-occlusive dysfunction, we report five cases and literature review. From 2012 to 2017, refractory impotence prompted five young men to consult us despite coil venous embolization performed elsewhere. All patients were evaluated with general x-ray, Doppler sonography, computerized tomography, the abridged 5-item version of the international index of erectile function (IIEF-5) and our dual pharmaco-cavernosography. They were treated with the latest method of penile venous stripping which was carried out with circumferential and pubic longitudinal approaches under acupuncture aided local anesthesia. The deep dorsal vein, cavernosal veins were thoroughly stripped while the para-arterial veins were ligated segmentally. Followup cavernosography was routinely conducted for confirming sufficient venous stripping and comparison of radio-opacity between the femoral cortex and the corpora cavernosa especially the penile crura while the IIEF-5 follow was merely made via the internet. A review of the literature on coil embolization was obtained using Medline. Coils migration took place in four patients in which each two were found in pelvic and pulmonary area respectively and one patient disclosed dozens of coils in the periprostatic plexus, all had no improvement in impotence. Postoperative cavernosography discloses the radio-opacity of the penile crura was denser than that of the femoral cortex. However, the IIEF-5 score changed from 10.4±2.4 to 15.9±2.8, p 0.001. One man required additional oral sildenafil and two men ended with a penile implant. Coil migration was not uncommon in the medical literature, which varied from 2.5% to 11.1%. The efficacy of penile venous embolization appears controversial, and its safety may not be sustainable although larger samples may be required.
 

Biography

Cun Tao Yu is one of the most famous cardiovascular surgeons in China. He is especially good at all kinds of operation of large vessels and has completed over 1500 operations such as total arch replacement and thoracoabdominal aortic replacement. Jin Lin Wu is his doctoral candidate. 

Abstract

Introduction: Isolated abdominal aortic dissection (IAAD) refers to aortic dissection (AD) inferior to the diaphragm, which is very rare. Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder, which is mostly presented as garliclike aortic aneurysm in cardiovascular system. To the best of our knowledge, no such a case concerning MFS presented as IAAD has been reported before. Case Report: A 37-year-old female with no history of hypertension was referred to our hospital for chest tightness. She had been initially diagnosed as spontaneous IAAD one month before with successful analgesic and antihypertensive treatment at a local hospital. On physical examination, the patient’s blood pressure was 138/80 mmHg. Laboratory tests showed D-dimer of 2.13 ug/ ml (<0.5 ug/ml), FDP of 8.42 ug/ml (0-5 ug/ml). Echocardiography revealed severe aortic regurgitation. CT showed an obvious compression of the left atrium by asymmetrical dilatation of noncoronary sinus. Abdominal aortic dissection originated distally to the superior mesenteric artery (SMA) ostium and extended downward to the bilateral common internal iliac artery. Then FBN1 mutation was found by gene analysis, thus the diagnosis of Marfan syndrome (MFS) was confirmed. She underwent Bentall procedure only and discharged on calcium channel blocker and warfarin. On follow-up at 1 year, the patient was doing well physically. CT scanning found no obvious extension of IAAD or aortic growth in diameter. Lessons: First, this is the first case report of MFS combined with both asymmetrical aortic root aneurysm and spontaneous IAAD, which enriches our understanding of the clinical manifestations of MFS. Second, we should take aorta as a whole organ in which multiple levels of lesions may occur simultaneously, so it is necessary to assess the whole aorta in order to prevent serious missed diagnosis. Third, for MFS patient with IAAD, conservative treatment under careful surveillance seems satisfactory on a short-term follow up. Further follow-up is still needed to confirm the long-term effect.
 

Biography

Yu Guo Xue is specialized on the diagnosis and interventional treatment of aortic diseases, including dissection, intramural hematoma, penetrating aortic ulcer, aneurysm, pseudoaneurysm and coarctation. Every year, more than 300 patients with aortic diseases underwent endovascular treatment at Beijing aortic diseases center. 

Abstract

Materials & Methods: From February 2009 to September 2016, 81 consecutive patients (70 men; mean age 63.4±7.9 years, range 32-79) underwent brachiocephalic bypass combined with stentgraft implantation (hybrid) and were enrolled in the study. Aortic pathologies included Stanford type B aortic dissection (n=22), aortic arch aneurysm (n=26), aortic arch pseudoaneurysm (n=14), aortic arch penetrating ulcer (n=11) and proximal endoleak (n=5) or pseudoaneurysm formation (n=3) after thoracic endovascular aortic repair (TEVAR). Hybrid repair comprised 3 landing in zone 0, 44 landing in zone 1 and 34 landing in zone 2. Simultaneous procedures included left subclavian artery embolization (n=57), endovascular abdominal aortic repair (n=1), coronary artery bypass (n=1), left common carotid endarterectomy (n=1) and renal stenting (n=4). Follow-up was performed at 1 month, 3 months, 6 months, 1 year and annually thereafter to investigate endoleak, patency of vascular graft and exclusion of aortic pathology. Results: Technical success was 100%. Instant endoleak was observed in 9 (11.1%, 7 type ï¼…, 2 type ï¼…) cases on postoperative angiography. Perioperative complications included iatrogenic ascending aortic dissection (n=1, 1.2%), stroke (n=2, 2.5%), anastomotic bleeding (n=1, 1.2%), both lower limbs thrombosis (n=1, 1.2%) and acute respiratory failure (n=2, 2.5%). Early morbidity was 8.6% (7/81). Early death occurred in 5 cases (6.2%) due to stroke, anastomotic bleeding, acute respiratory failure and sudden death. Follow-up was complete in 100% for 39.4±14.5 months (range 1-81 months). During follow-up, all the vascular grafts were patent. The overall endoleak rate was 13.58% (11/81). Late mortality was 6.2% (5/81) and morbidity was 14.5% (8/81). Conclusions: Hybrid repair of aortic pathologies involving aortic arch is safe and effective with good short and mid-term results, greatly expanding the indication of endovascular aortic repair.
 

Biography

Dr. Lin manages the varicose veins with the assistance of endoscopic surgery to decrease the recurrence rate. He also performs immediate breast reconstruction with pedicled transverse rectus abdominis myocutaneous flap. He is specialized in the field of fat grafting and wound healing.

Abstract

Aims:Venous ulcers of primary varicose veins were managed through endoscopic assisted surgery. Materials and Method: Between January 2004 and December 2016, 1241 legs with primary varicose veins were operated on through endoscopic-assisted surgery. Patients of secondary varicose veins were excluded. Of the 78 patients who had C6 ulcer were included in this study, 23 (29.5%) were male and 55 (70.5%) were female. 44 patients (56.4%) had venous ulcer on the left leg, 34 patients (43.6%) on the right leg, and 5 (6.4%) on both legs. The mean patient age was 59 years (range 30-84 years). The clear illumination and magnified monitor view offered by an endoscope enable the identification of the varicose and non-varicose veins. The operation procedures will be demonstrated in a video. (https://drive.google.com/ open?id=0B9GW1JJYL1niVi1BNE1xZGxaek0) Before the operation, the causative vein of the ulcer was detected and marked after the patient standing for 10-15 mins. The engorged vein proximal to the ulcer lesion is highly suspected as the causative vein. The causative varicose veins could be identified definitely and dissected precisely from its proximal end and was along the whole vein down to the periphery and/or the base of the ulcer. Frequently, the associated incompetent perforating vein was dissected and divided. The causative veins were totally excised. Results: The varicose veins were traced to the base or periphery of the 66 ulcers. 88.5% of the ulcers healed within 14 weeks. Two recurrent ulcers occurred due to residual varicose veins. KaplanMeier analysis revealed a five-year recurrence rate of 0.0%. Conclusion: In management of venous ulcer of primary varicose vein, endoscopic assisted surgery is a good alternative to achieve a low recurrence rate and high satisfaction rate.
 

Biography

Associate Professor Mingjie Gao has worked in the field of vascular ultrasound for more than 10 years and has good expertise in lower extremity artery ultrasound. Her research focuses on the following areas: 1) Systemical evaluation of the vessel structures and hemodynamics in lower extremity artery by multiple-modes of ultrasound in patients with peripheral arterial disease. 2) Evaluation of the vessel structures and hemodynamic alterations before and after interventional therapy such as stenting. She and her study group also performed a series of studies in the risk factors for SFA in stent restenosis. She has published almost 10 articles in the above areas. 

Abstract

Objective: This retrospective study determined the duplex ultrasound scanning (DUS) criteria for detecting 50-69% and 7099% stenosis of the superficial femoral artery (SFA). Methods Examinations of 278 limbs in 185 subjects with peripheral arterial disease were performed. Duplex ultrasound scanning was used to measure the residual diameter of the stenotic segment and the diameter of the original lumen, the peak systolic velocity (PSV) at the stenotic segment of the SFA (PSVst), the segment proximal to the stenosis (PSVpro), and the popliteal artery (PSVpop; distal to the stenosis). The ratios PSVst/PSVpro and PSVst/PSVpop were calculated. Receiver operator characteristic curves were plotted, with digital subtraction angiography as the reference. Results: The studied limbs included 205 limbs with stenotic SFAs: 43 (15.5%) with 50-69% stenosis, and 162 (58.3%) with 70-99% stenosis. The control group consisted of 73 limbs: 44 (15.8%) were normal and 29 (10.4%) had <50% stenotic SFAs. According to the results of the ROC analysis, the optimal cut-off values for detecting 50-69% stenosis of the SFA were PSVst ≥ 210 cm/s, PSVst/PSVpop ≥ 2.5, or PSVst/PSVpro ≥ 1.7. PSVst was the most useful hemodynamic parameter for predicting 50-69% stenosis, with 95.6% sensitivity, 98.6% specificity, and 96.4% accuracy. For predicting 70-99% stenosis of the SFA, the thresholds were PSVst ≥ 275 cm/s, PSVst/PSVpop ≥ 4.0, or PSVst/PSVpro ≥ 2.5. PSVst/PSVpop ≥ 4.0 was the most useful Doppler parameter, with 96.3% sensitivity, 93.9% specificity, and 95.3% accuracy. PSVst/ PSVpopï¼…PSVst was the best combined parameter to detect SFA 70-99% stenosis with 96.3% sensitivity, 94.8% specificity, and 95.7% accuracy. Conclusions This study determined the cutoff values of DUS hemodynamic parameters for diagnosing 50-69% and 70-99% stenosis of the SFA. PSVst/PSVpop may be a better ratio parameter than the traditional parameter of PSVst/PSVpro for diagnosing SFA stenosis, especially for 70-99% stenosis
 

Biography

Mónica M Torres Fonseca is a Vascular Surgeon who, along with her clinical work, devotes a large part of her time to the field of research, which she is passionate about. She and her group’s work are mainly directed to the study of AAA for years. This is the object of study in her doctoral thesis, based on the diagnosis, prognosis and treatment of AAA through clinical and experimental studies. She is concerned about the situation of patients with AAA without surgical indication, who cannot be offered effective medical treatment at this time. Therefore, part of their study aims to determine possible particles that can reduce or delay the progression of the aneurysm, which would mean a substantial change in the prognosis of these patients. 

Abstract

The evolution of abdominal aortic aneurysm (AAA) is unpredictable. Moreover, no specific treatment exists for AAA, except surgery to prevent aortic rupture. Galectin-3 has been previously associated with cardiovascular disease (CVD), but its potential role in AAA has not been addressed. Galectin-3 levels were increased in plasma of AAA patients (n=225) compared to controls (n=100). Moreover, galectin-3 concentrations were associated with need for surgical repair, independently of potential confounding factors. Galectin-3 mRNA and protein expression were increased in human AAA samples compared to healthy aortas. Experimental AAA in mice was induced by aortic elastase perfusion. Mice were treated intravenously with the galectin-3 inhibitor modified citrus pectin (MCP, 10 mg/kg, every other day) or saline. Similar to humans, galectin-3 serum and aortic mRNA levels were also increased in elastase-induced AAA mice compared to control mice. Mice treated with MCP showed decreased aortic dilation, as well as elastin degradation, vascular smooth muscle cell (VSMC) loss and macrophage content at day 14 post-elastase perfusion compared with control mice. The underlying mechanism(s) of the protective effect of MCP was associated with a decrease in galectin-3 and cytokine (mainly CCL5) mRNA and protein expression. Interestingly, galectin-3 induced CCL5 expression by a mechanism involving STAT3 activation in VSMC. Accordingly, MCP treatment decreased STAT3 phosphorylation in elastase-induced AAA. In conclusion, increased galectin-3 levels are associated with AAA progression, while galectin-3 inhibition decreased experimental AAA development. Our data suggest the potential role of galectin-3 as a therapeutic target in AAA