Non-Invasive Vascular Diagnosis Symposium Features Latest Literature, Testing Algorithms, and More

Attendees will learn diagnosis and interpretation of testing done in the carotid circulation, in the peripheral venous and arterial circulation, and in the mesenteric circulation in the Non-Invasive Vascular Diagnosis symposium, which begins at 8:00 AM on the first day of ISET 2019. The symposium is designed to be comprehensive and will feature multiple educational tactics and interactive polling and challenges. James Benenati, MD, of Miami Cardiac & Vascular Institute, will be moderating the symposium, and he answered a few questions about what the session entails.

Who will benefit from attending this symposium?

The symposium is geared towards physicians of any specialty (cardiology, vascular surgery, interventional radiology, vascular medicine, and neurology) who work in a non-invasive vascular laboratory. The areas of interest include carotid testing, venous testing, arterial testing, and mesenteric testing. The session is also designed for technologists who work in vascular laboratories and do vascular scanning.

This is an all-day symposium that focuses on non-invasive vascular laboratory examinations and is very practical and interactive. There will be audience polling and surveys throughout the presentations, and the symposium will end with a trivia competition that includes vascular physics, vascular history, scanning  techniques, and interpretation of vascular tests.

The program is divided into a half day focusing on cerebral vascular and carotid testing and a half day on arterial, venous, and mesenteric testing. The  program will cover the hot topics in scanning techniques, scanning interpretation, findings, and new tests that are being developed and rolled out.

The session is geared towards interpretation and findings, but we also scan a patient live so that we can demonstrate techniques and have a multidisciplinary panel comment on the findings. We look for pitfalls, tips, and techniques in scanning.

Can you give an overview of some of the morning presentations?

The morning will begin with “Beyond the DX of PAD: What Do Arterial Exam Results Predict for the Patient's Future M&M?” with Michael Jaff, DO. Patients with PAD often have coronary disease and carotid disease, and testing for arterial disease alone is not enough. This presentation by Dr. Jaff will examine the correlation between PAD and coronary disease and give insight into life expectancy and survival in patients with known PAD.

Dr. Jaff’s presentation will be followed by an important talk by Eugene Zierler, MD, titled “What Are the SVS Practice Guidelines on Follow Up After Arterial Interventions?” The Society of Vascular Surgery has created practice guidelines for who should be tested and treated, and Dr. Zierler is going to review these guidelines and what they mean in terms of who should and should not be treated.

Another great presentation is “Evaluating the CLI Patient: What Testing Options Are There?” by Nicos Labropoulos, PhD. Critical limb ischemia (CLI) is a national epidemic and many patients go undiagnosed, leading to limb loss and amputation. Dr. Labropoulos will discuss the best ways to diagnose and treat these patients. It’s very difficult to test patients for CLI because they have heavily calcified vessels, and pressures and indices are falsely elevated. Sometimes more sophisticated evaluation is necessary to determine how much ischemia is truly present, and all these areas will be reviewed.

Laurence Needleman, MD, will be presenting on calf vein thrombus. He will discuss many of the controversies about treatment algorithms and testing for calf vein thrombus. These findings are often controversial, and it is debated whether we should even do this type of testing.

Later in the morning, there will be a talk by Ian DelConde, MD, on the use of D-Dimer in deep vein thrombosis (DVT) evaluation. DVT is a common diagnosis in the emergency department (ED). Large numbers of studies are done in the ED and one way to improve efficiency and decrease unnecessary testing is to do adequate screening before ordering the studies. Dr. DelConde will review adequate screening strategies for patients who have suspected DVT.

We’ll close out the morning with a panel discussion. Everyone involved in vascular medicine experiences the challenge of treating patients who have had examinations done at other facilities. There are reimbursement issues when we order repeat testing. There is no consensus on how to manage this issue, but the panel will include opinions from different experts on what they do to ensure the best medical care for patients being evaluated with outside studies. When do the experts repeat studies? When do they elect not to repeat studies? And how do they determine if the imaging done prior to the patient arriving in the office is adequate or not?

What can attendees expect in the afternoon?

When the session resumes in the afternoon, we’ll begin with an important presentation by Joshua Beckman, MD, MsC, on determining high- and low-risk patients based on plaque morphology. Most physicians grade carotid artery stenosis and determine patients’ risk based on degree of stenosis. However, it is not necessarily the degree of stenosis but the character of the plaque that determines the risk. Dr. Beckman will talk about imaging plaque and using that imaging in conjunction with, but possibly even more importantly than, the degree of stenosis to determine someone’s risk for stroke.

The afternoon also includes a session by John Pellerito, MD, on carotid waveforms and manifestations of local and systemic disease. Dr. Pellerito will discuss carotid duplex waveforms and evaluation of the carotid arteries. However, those waveforms are a mirror to the rest of the body and can provide insight into other issues besides carotid stenosis, such as heart failure and various problems with heart valves. The waveforms give us an idea of the global state of the entire vascular system. Dr. Pellerito will review how we can use waveforms to assess more than just the carotid arteries.

Laurence Needleman, MD, will present “A Standardized Carotid Velocity Criteria: Where Do We Stand?” There are more than 2 dozen criteria nationwide to determine carotid artery stenosis. There’s not a uniform consensus on which criteria are the best, and oftentimes medical management and surgical management are based on diagnosis made by duplex. Dr. Needleman will review some of the latest findings from a recent study that is trying to standardize carotid artery interpretation.

Later in the afternoon, Dr. DelConde will present, “Non-Invasive Testing for PFO: The Role of Transcranial Doppler Bubble Studies.” PFOs are common, and there are now endovascular treatment methods for PFOs. In many studies, transcranial Doppler has proven to be more sensitive than any other testing modality. Dr. DelConde will review the data and the findings with transcranial studies for PFO.

Can you tell us more about your own presentation?

My own presentation is an overview of interesting lower extremity arterial cases, focusing primarily on lower extremity arterial testing. It will be an interactive learning experience that will cover many of the subtleties of arterial medicine and tips and tricks in interpretation.

What makes the Non-Invasive Vascular Diagnosis symposium a “can’t miss” session?

This is an outstanding one-day review of non-invasive testing that includes all areas of non-invasive examination and keeps physicians and technologists up to date on the latest literature and recent testing algorithms. We want participants to take information back to improve their own laboratories, testing protocols, and interpretation ability. There is something for everyone in this symposium.