Vascular and Endovascular Controversies Update: 40 Years of Looking Forward

Selected chapters are found under the clear sections of the book: Controversies —Acute Stroke—Thoracic Aortic—Abdominal Aortic—Peripheral Arterial Ischaemia—Venous and Lymphatic. The book is certainly up to date as it was written before the chapters were spoken to a large audience at the 40th celebration of the Charing Cross International Symposium to take place in Olympia Grand in the west of London.
It is hard to focus on particular high spots. Acute Stroke Controversies include the CCSVI appraisal by Lindsay Machan. In this chapter, essentially, Machan and his co-author dispel the concept that this intervention affects the natural history of the underlying condition. The patients have needed to know whether an intervention would alter the natural history of their condition. False hopes needed to be corrected and we have the latest information on the subject. It is important for specialists to know that the procedure should not take place if this gives inappropriate encouragement to the patients that they will be cured by intervention. It seems unlikely that they will be improved but at least it has done no harm.
The Thoracic Controversies section includes presentations on new thoracic aortic procedures. Perhaps the cutting edge of the whole Charing Cross Symposium in 2018 is the realisation that the arch of the aorta can be reconstructed by endovascular means. However, interventions come at a risk of stroke. This was realised with the transcatheter aortic valve implantation (TAVI). Cerebral protection devices were introduced to try to limit this. Chapters in this section relate to information to control cerebral embolisation. At the meeting, results of the so-called STEP study will be discussed. Experts share their information on how to eradicate Stroke from Thoracic Endovascular Procedures. This will be illustrated by an “aortic live” performance of an endovascular arch reconstruction to show the audience just what the concerns are and how to minimise the risks. Unfortunately, in this publication that movie cannot be shown but will be online after CX.
Venous and Lymphatic Controversies focus on how to investigate, how to intervene, best effect of these conditions. Superficial venous management has moved very much towards the use of cyanoacrylate glue occlusion. This can be done without tumescent anaesthesia. Some have found mild allergies following this procedure and the pros and cons of the use of cyanoacrylate are discussed in the book.