November 19, 2018
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The Take Home: SVS

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Source: Nationwide Photographers. Printed with permission.

Vascular surgeons, interventional cardiologists, interventional radiologists and a wide variety of other health care professionals turned out for the Society for Vascular Annual Surgery Vascular Annual Meeting, held July 20-23 in Boston. Cardiology Today’s Intervention spoke to several attendees to discuss their highlights from the meeting. The experts include Christopher J. Abularrage, MD, from Johns Hopkins Hospital, Alik Farber, MD, from Boston Medical Center and Boston University School of Medicine, and Angela Kosie, ACNP-BC, ANP-BC, from Cleveland Clinic.

Christopher J. Abularrage, MD

The session that I found most interesting was the combined session with SVS and the American Podiatric Medical Association. This is conducted every year as a postgraduate education course. It includes lectures from experts in vascular surgery and podiatric surgery.

The presentations highlighted the collaboration that goes on across the country between podiatrists and vascular surgeons. This year they mainly highlighted the diabetic foot, and how the partnership between podiatric and vascular surgeons can lead to improved care. The collaborations demonstrated and the questions raised from year to year are exemplary.

Christopher J. Abularrage

The session highlighted three main themes. No. 1, multidisciplinary teams are becoming the standard of care for management of diabetics with peripheral vascular disease. No. 2, the vascular surgery talks were cutting-edge in terms of what procedures are being performed below the knee, and outcomes from those. No. 3, all of this was combined with discussions on the management of complex foot wounds. One of the major developments of the last few years is the integration of the WiFi classification for lower-extremity ischemic foot wounds. The older literature has overall outcomes for limb salvage, but does not give a good feel for what the surgeons were dealing with at the start, whether a minor toe ulcer or significant gangrene. What I gathered from this session is that the incorporation of the WiFi classification is becoming relatively standard in newer publications and presentations. This gives people a better idea of what is necessary to heal each type of wound.

There were a lot of talks by podiatric surgeons and plastic surgeons on reconstruction of foot wounds. I have incorporated many of these points into my practice more.

There were also multiple discussions on the concept of the angiosome: When it is important, when it is not and how to incorporate that information into your practice. It takes some effort to calculate a WiFi classification score, decide on whether to use an angiosome and which one, and then consider the depth of the wound and other characteristics. Putting all that together takes work, but you come to realize the more you incorporate these factors into your practice, the better the outcome is for the patient. It is helpful to work with a team that understands what each other is doing in order to streamline care and break down barriers.

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Alik Farber, MD

The meeting was outstanding on all fronts, educationally and socially. There was a lot to learn from both a clinical and applied research perspective.

Two topics were particularly memorable to me. The first was a dedicated activity for physician assistants. We have been trying to engage with physician assistants, many of whom work with vascular surgeons, interventional cardiologists and radiologists. This had a very good turnout, resulting in a packed room. It was split up into topics such as peripheral artery disease, carotid artery disease and aortic disease. The physician assistants presented some great cases. There were also presentations from vascular surgeons. It was very rewarding to get a group of advanced practice providers who work in the field of vascular surgery together to spend time and learn from one another. There was a lot of focus on teamwork and collaboration.

Alik Farber

The second session of interest was a postgraduate course dedicated to the diabetic foot. It showed how there is an opportunity for podiatrists and vascular surgeons to collaborate. Representatives from both specialties presented and again, the room was packed. The session was a recognition of the fact that these two fields work together to treat the feet of patients with diabetes, and there is an opportunity to learn from one another. I learned from the podiatrists’ talks, and I’m sure the podiatrists learned from the vascular surgeons’ talks. Typically, vascular surgeons improve circulation. Many of us also do wound debridement and wound care. But we are not trained how to offload feet, eg, how to place the patient in special orthotics. We are not trained in various foot amputations, such as Chopart or Lis franc amputations. We are not trained in the management of the charcot foot; there was a talk by a podiatrist from our institution, Geoffrey M. Habershaw, DPM, on that topic. Most vascular surgeons don’t learn about this, but we see patients with wounds or critical limb ischemia that have a charcot foot.

There was also a lot of talk about a multidisciplinary limb preservation team: What is involved with it and who needs to get together to take care of these patients. You need multiple physicians to treat these patients successfully. Also of note was a presentation on advanced wound care by Emily A. Cook, DPM, MPH, from Mount Auburn Hospital in Cambridge, Massachusetts.

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Angela Kosie, ACNP-BC, ANP-BC

Angela Kosie

I enjoyed reuniting with 22 of the surgeons that I’ve had the opportunity to work with at this year’s SVS annual meeting. There were a large selection of post-graduate courses, workshops and forums where thousands of vascular surgeons from all over the world shared their approach and the research that stood behind it. There were other medical specialties that had their input as well. One session that particularly stood out to me was a video session called “How I Do It.” For those of us who don’t work in the operating room, it was fascinating. Many times, after receiving patients from the OR, surgeons talk shop, particular tools they use and special surgical approaches. Sometimes it’s a different language. It was nice to have a better understanding/picture of what actually takes place in these frequently complex surgeries.

The Society for Vascular Nursing (SVN) had their annual meeting during the first 2 days of SVS. As an acute care nurse practitioner in a vascular surgery ICU setting, I greatly appreciated how often the importance of a team approach was mentioned at both SVS and SVN. The multidisciplinary approach in the care of vascular patients from start to surgical finish and follow-up should continue to be utilized.

Overall, this conference was fantastic.

Disclosures: Abularrage and Kosie report no relevant financial disclosures. Farber reports he is co-principal investigator of the BEST-CLI trial sponsored by the NIH.