Procured Health medical device experts Vikram Karandikar and Kelsey Peterson recently attended the Chicago EndoVascular Conference (CVC). Below they trade thoughts about some recent advances in the field.
Intravascular Imaging Modalities
Vikram Karandikar (VK): I was excited by the amount of discussion about the use of alternative imaging modalities to traditional radiography. A lot of the presenters were enthusiastic about their experience with intravascular ultrasound (IVUS) during peripheral interventions and the ability it gave them to view vessel wall morphology in vivo. What were your thoughts, Kelsey?
Kelsey Peterson (KP): It was interesting that the speakers we heard felt that angiography often underestimates the amount of disease present in a vessel, and that IVUS provides more detailed plaque morphology. They emphasized that IVUS can also help assess the completeness of therapy and minimize the risk of dissection.
VK: Right. Most physicians at CVC were advocating for routine use of IVUS, although I should mention that several commented on the lack of reimbursement for all sites of care. In our review of the evidence, the number of level 1 studies evaluating the efficacy of IVUS systems in peripheral vascular applications is still limited, and we need to see more higher-level studies comparing it to angiography.
Selection of Atherectomy Devices
KP: The consensus among speakers was that atherectomy is a useful adjunct treatment to balloon angioplasty in patients with more severe, highly calcified lesions.
VK: As we at Procured Health have seen in our analysis of peer-reviewed literature, clinical trials and safety data, there’s no shortage of atherectomy devices on the market. The physicians tended to agree that all of them have been studied and are efficacious; the key is to use one device often and become a master.
KP: I agree, Vikram. Physicians should generally limit themselves to two to three devices and become proficient with those.
Transcaval access for transcatheter aortic valve replacement (TAVR)
VK: What was your take on the new session they added on “Large Bore and Transcaval Access”?
KP: It definitely set the stage for a spirited discussion. We heard a range of opinions on the use of innovative surgical techniques to treat patients when conventional arterial access isn’t possible, whether due to severe peripheral arterial disease or small vessel size. The use of caval-aortic or “transcaval” access for TAVR received particular attention from presenters.
VK: And we saw a video of a live surgical case! Transcaval TAVR debuted in 2014, and the team behind it recently published promising 30-day results from a prospective, multicenter trial. Additional study with long-term outcomes is needed to further validate this technique and compare its efficacy to existing non-conventional approaches for TAVR (such as transapical, transaortic or trans-subclavian).
Thanks to Vikram and Kelsey for their insights. Our research team consistently monitors for updates on dynamic devices such as the three discussed here and will continue to apprise our clients of any changes to indications or financial impact.
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