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This year marks the 33rd annual meeting of the European Society for Vascular Surgery (ESVS), Europe’s leading scientific meeting for vascular surgery. The meeting took place in Hamburg, Germany, and offered a rich scientific programme, which included 200 fast-track oral presentations, more than 200 poster presentations, as well as expert faculty-led symposia showcasing the very best of recent research and innovation in the field.
The president of the ESVS, Professor Henrik Sillesen, described the ESVS as a “uniting society” bringing together all aspects of vascular medicine and highlighted the multifaceted role of vascular surgeons, stating “The role of vascular surgeons includes evaluation of the patient, imaging, surgical procedures, medication and treatment follow-up”. He continued his address urging vascular surgeons to commit to a more holistic approach in the provision of therapeutic options to enhance patient care, stating “Vascular surgeons need to adapt working conditions to current time!”
The 33rd annual meeting of the European Society for Vascular Surgery hosted in Hamburg, Germany
More than 200 million people worldwide are estimated to experience lower extremity peripheral artery disease (PAD).1 In addition, patients with PAD are at high risk for the development of life-threatening major adverse cardiovascular events (MACE) and major adverse limb events (MALE).2 Patients with PAD have a poor prognosis with a higher reported 5-year mortality rate than patients with breast cancer or Hodgkin’s lymphoma.3,4 As such, the ESVS programme included an expert-led symposium, entitled “How can we improve the treatment for patients with PAD? Insights from COMPASS”.
Professor Bauersachs kicked-off the session by providing an engaging overview of the available clinical evidence and recent guideline updates for the treatment of patients with PAD. During his overview, he highlighted the value of rivaroxaban vascular dose plus aspirin in improving patient outcomes, stating that: “The dual pathway inhibition (DPI) regimen used in COMPASS is the first antithrombotic regimen to significantly reduce both MACE and MALE, representing a major advancement in the management of PAD.
In the COMPASS trial, the rivaroxaban vascular dose on top of aspirin was associated with a 28% reduction in MACE and a 46% reduction in MALE providing reassurance to doctors and patients considering its use.
Professor Bauersachs noted the stark recognition of the COMPASS trial data by guideline committee members, with COMPASS trial data paving the way for 2019 guideline recommendations for the management of patients with PAD and chronic coronary syndromes (CCS). Guideline updates included the 2019 Global Vascular Guidelines (GVG), the European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) 2019 diabetes guidelines, and the ESC guidelines.
During the discussion, Professor Sillesen remarked on the consistency of the 2019 guidelines in the recommendation of the rivaroxaban vascular dose plus aspirin and described it as: “A progressive step in the management of patients with PAD”.
Symposium on improving outcomes in patients with PAD in the new era of DPI presented by Professor Rupert Bauersachs (session Chair), Professor Henrik Sillesen (ESVS President) and Professor Sebastian Debus (ESVS Secretary General) at the 33rd annual meeting of the ESVS
An interactive patient case-based discussion, presented by Professor Debus and Professor Sillesen, put the evidence from the COMPASS trial and the latest guidelines for the management of patients with PAD into perspective. In this session, the audience was polled on their clinical decision-making for the treatment of patients with PAD, acute limb ischaemia and coronary artery disease. During the session, expert faculty shared their experiences with the audience and provided practical considerations for the best practice use of DPI in each scenario. Professor Debus advocated the importance of such sessions at the ESVS conference, stating: “Helping vascular surgeons translate clinical evidence into everyday practice is key to improving patient care, particularly for patients who are high risk and have a poor prognosis.”
Professor Debus concluded the symposium session with the presentation of a treatment algorithm to guide decision-making for the management of patients with PAD. He also reiterated the role of the vascular surgeon in the provision of a more holistic approach to patient care. This sentiment was reinforced by Professor Bauersachs, who urged all attendees to develop and implement similar treatment pathways in their own hospitals and practices.
Treatment pathway for the management of patients with peripheral artery disease presented by Professor Debus and adapted from Hussain et al, 2018.7
The ESVS 2019 meeting has yet again provided an exceptional scientific programme supporting the translation of guidelines and the very best clinical evidence into everyday practice. The congress highlighted the need for vascular surgeons to consider a more holistic approach including medical treatment in the provision of therapeutic options which enhance patient care and provide improved patient outcomes. In patients with PAD, for whom the prognosis is dire, these treatment approaches are of the utmost importance. The COMPASS trial results and the benefit of DPI in preventing devastating MACE and MALE events in patients with PAD were highlighted at ESVS. In addition, the latest independent guidelines presented at ESVS demonstrate marked consistency on the use of rivaroxaban and pave the way for the implementation of evidence-based changes in treatment practices that will continue to enhance patient care and protect against life-threatening thrombotic events. However, for this to be realised in routine clinical practice, clear treatment pathways to guide best practises for the management of patients with PAD and the use of DPI are available and should be implemented.