3D printing

SOCIETY BRIEFS Compiled by Beth Bales and Kristin Crowe

SVS WEBINAR ON 3D PRINTING SHOWCASES HOW TECHNOLOGY COULD AFFECT CURRENT AND FUTURE PRACTICE

THE RECORDING OF THE SOCIETY FOR VASCULAR

Surgery (SVS) webinar on three-dimensional (3D) printing in vascular surgery is now available on the SVS website.

The SVS Health Information Technology Committee (HIT) held the webinar, “3D Printing for Vascular Imaging,” in December 2022. Committee Chair Judith Lin, MD, and member Dan Kassavin, MD, co-moderated the webinar. Nick Carruthers, MD, Stacy Fisher, MD, Jeffrey Hirsch, MD, and Nicholas Osborne, MD, presented various aspects of 3D printing and its uses.

“Three-dimensional imaging is becoming an essential tool in the workplace, including in medicine,” said Lin.

Carruthers began the webinar with an overview on the use of 3D as well as a demonstration of how to “create a model from a CT scan and then print it mainly using consumer-grade printers and materials available to almost anybody.”

Osborne demonstrated, in-depth, how to use the technology for complex aneurysm planning and practice for actual surgery. His conclusions are that such printing in these cases has value in planning, in education for residents, explaining details to patients, and operating room back-table customization.

Fischer and Hirsch related how using 3D printing to make surgery safer for Fischer’s congenital heart disease patients led to requests from vascular surgeons to similarly help with aneurysm repair. The two also discussed which kind of imaging has led to the most success in 3D modeling; software; future directions, including personalized medicine with 3D models as part of a patient’s records; education; consultation with other providers; and more.

Scenes from 3D printing webinar

“3D printing has become the largest instructive technology shift since the internet,” Lin said at the webinar’s conclusion. “It’s fascinating to see where technology will take us in the future and definitely something we look forward to.”

The panelists’ information could “affect your current and future practices,” she told webinar participants, and the information presented during discussion could help surgeons take better care of their patients via various innovations. “Our next step is to strive for improvements in vascular care using these modern technologies,” she said. “Let’s innovate.”

To view the recording visit vascular.org/3DprintingRecording.

Sean Lyden, MD, is now

SPOT LIGHT chief medical consultant for VESTECK and has joined the VESTECK Scientific Advisory Board. VESTECK is an early-stage medical device company focused on the aortic repair and structural heart markets. Lyden chairs the Society for Vascular Surgery (SVS) Government Relations Committee and sits on the SVS Advocacy Council, and the Political Action Committee (PAC) Steering and Postgraduate Education committees.

Louis Kozloff, MD, a former varsity swimmer at the University of Pennsylvania, with his wife, endowed a swimming and diving head coaching position to the university. Kozloff is a vascular surgeon in North Bethesda, Maryland, and a professor of surgery at the George Washington University Medical Center. He and wife, Rene, both are Penn graduates.

Thomas Maldonado, MD, has been named chief medical officer for Koya Medical, which is developing treatments for lymphedema and venous diseases.

New CPT Codes for percutaneous arteriovenous fistula creation

By Sunita Srivastava, MD, and David Han, MD

FOR THE 2023 CURRENT

Procedural Terminology (CPT) code set, two new codes (36836 and 36837) have been added that describe percutaneous arteriovenous (AV) fistula creation in the upper extremity. The most significant material difference between these two procedures is that one approach requires two catheters from two different percutaneous access sites, one in the vein and one in the artery that are then approximated using magnets. The other technique requires a single percutaneous access that connects the artery and the vein under ultrasound guidance and then uses mechanical capture for approximation.

Both codes include all vascular access, angiography, imaging guidance, radiologic supervision and interpretation, and blood flow redirection or maturation techniques—for example, transluminal balloon angioplasty or coil embolization—that are performed for fistula creation. Prior to 2023, there were only open surgical codes available for reporting an AV fistula, requiring a surgical cutdown to expose the artery and vein, vein dissection, ligation of venous branches, arteriotomy, and suturing of the vein to the arteriotomy. The coding descriptions for the open access procedures (36818, 36819, 36820, 36821) also include completion ultrasound and completion contrast angiography, if performed.

New codes 36836 and 36837 will have a 0-day global assignment, which means that any services or procedures performed on a day other than the date of the procedure may be separately reported. Surgeons also should keep in mind that percutaneous AV fistula creation in any location other than the upper extremity should be reported with code 37799, Unlisted procedure, vascular surgery.

‘GATSBY’ GALA TICKETS ON SALE BEGINNING JAN. 20

BOOK YOUR TRIP TO THE

Roaring Twenties early, and save some money, perhaps for auction items.

Early-bird ticket sales for the Society for Vascular Surgery (SVS) Foundation’s “Great Gatsby Gala,” to be held at the 2023 Vascular Annual Meeting (VAM), begin Jan. 20. Tables of 10 will be available for $5,000, $7,500 and $12,000.

This year’s Gala will transport attendees to the 1920s and the Jazz Age, the setting for the classic F. Scott Fitzgerald tale of mysterious millionaire Jay Gatsby. The “Gatsby Gala” will be held the evening of June 16 and will include the Surgeon Speakeasy Cocktail Reception, dinner, entertainment, live and silent auctions, and dancing. All proceeds will benefit the SVS Foundation and its efforts to fund the future of vascular health.

Individual ticket sales will start at $500, beginning Jan. 20. This year, the Foundation is pleased to make a limited number of tickets available for young surgeons. “All of us involved in planning the Gala know that our young surgeons would probably find it hard to swing a $500 ticket,” said Gala Co-Chair Leigh Ann O’Banion, MD. “But as the future of the specialty and our Society, we want them to participate in this celebration of all things vascular.”

Besides general sales, the SVS is offering a number of sponsorship opportunities and table ticket levels.

For more information, visit vascular.

org/2023gala.

Membership clears bylaws changes

THE SOCIETY FOR VASCULAR

Surgery voting membership voted to approve proposed changes to the bylaws that will change the composition of the Society’s Nominating Committee. A minimum of 150 votes is required to establish quorum and this was exceeded with 284 votes registered. A two-thirds majority of those voting is required for bylaws passage, and this was exceeded with 77.5% support. Members voted in favor of three revisions to Article X of the SVS bylaws.

The committee’s size will remain the same, at seven members, but expand the diversity of perspective.

The changes affect the process for nominating SVS officers for 2023–24, which begins this month. The chair of the 2023 Nominating Committee is Kim Hodgson, MD.

ESVS AAA guidelines alert recommends ‘enhanced surveillance’ in patients treated with Nellix device

IN A NEWLY RELEASED “FOCUSED UPDATE” TO

their 2019 recommendations, the European Society for Vascular Surgery (ESVS) abdominal aortic aneurysm (AAA) guidelines writing committee has published advice on the surveillance and management of patients treated with the Nellix endovascular aneurysm sealing (EVAS) system (Endologix).

The committee advises that all patients in whom a Nellix device has been implanted “should be identified, properly informed and enrolled in enhanced surveillance.” If device failure is detected, it states that “early elective device explant should be considered in surgically fit patients.”

The alert, authored by Jon Boyle, MD, from Cambridge University Hospitals NHS Trust and University of Cambridge in Cambridge, England, et al was published online ahead of print in the European Journal of Vascular and Endovascular Surgery (EJVES).

Boyle and colleagues note that they performed a scoping review of risk for late serious aortic-related adverse events in patients treated with EVAS for AAA based on a literature search in PubMed up to Dec. 7, 2022. Following synthesis of the available evidence, the writing committee agreed on recommendations graded according to the European Society of Cardiology (ESC) grading system.

“EVAS has a very high incidence of late endograft migration resulting in proximal type 1 endoleak with risk of rupture, requiring open conversion with device implant,” the authors write, detailing their key finding from the review. They add that Nellix device the reported mortality for elective explantation varies between 0% and 14%, while acute conversion for rupture has a “very dismal prognosis” with 67–75% mortality.

The authors detail that ESVS guidelines are renewed every five years or so, and that ESVS focused updates are issued “to convey important new data that have emerged in between the publication of the full guidelines, that affect patient safety or impact decision-making or management of the patients.”

In their 2019 guidelines on the management of abdominal aortoiliac artery aneurysms, the writing committee recommended that “conceptual new technologies, such as [EVAS], should only be used within studies approved by research ethics committees and with informed consent, until properly evaluated.”

In May of last year, Endologix ended

Medtronic announces first enrollment in head-tohead global randomized trial evaluating durability of EVAR

MEDTRONIC HAS ANNOUNCED THE

first patient enrollment in the ADVANCE trial, a head-to-head randomized controlled trial of two aortic stent graft systems, the Medtronic Endurant II/IIs system and Gore Excluder AAA device family systems.

The ADVANCE trial is a global, postmarket, prospective, interventional, multicenter study that will enroll a minimum of 550 patients at up to 50 centers globally. Patients will be randomized to receive endovascular aneurysm repair (EVAR) with either the Endurant family or Excluder family grafts, and will be followed at one month, one year, and annually through five years. The first patient in the ADVANCE trial was enrolled by the team led by Ray Workman, MD, at Novant Health Forsyth Medical Center in Winston-Salem, North Carolina.

“Through the ADVANCE trial, we are working to deepen our evidence of sac regression as a key indicator of long-term EVAR patient outcomes,” said Hence Verhagen, MD, professor of vascular surgery at Erasmus Medical Center in Rotterdam, the Netherlands, and co-principal investigator of the trial. “Our hope is that the findings will allow physicians to make evidence-based clinical decisions to improve long-term patient outcomes.”

The ADVANCE trial aims to further the understanding of sac regression by robust evaluation of CT imaging utilizing an independent core lab through five years. The trial will provide a comparison of aneurysm sac regression outcomes between the Medtronic Endurant II/IIs stent grafts and the GORE Excluder AAA stent grafts with additional evidence to analyze risk factors related to aneurysms that fail to regress. The trial will also compare other key clinical outcomes between the two stent grafts, including endoleaks, migration, secondary interventions, mortality, and renal complications.

“We are pleased to announce the first patient enrolled in the ADVANCE trial,” said Marc Schermerhorn, MD, chief of vascular and endovascular surgery, Beth Israel Deaconess Medical Center in Boston, and co-principal investigator of the trial. “This milestone underscores the commitment to rigorous study of the long-term data around the durability of the Endurant system for patients in need of EVAR. The results of the trial aim to demonstrate contemporary outcomes and our overarching goal to deliver superior aortic patient care through robust and rigorous clinical data.”

The ADVANCE trial draws on clinical data showing that one-year sac regression is an early indicator of improved long-term survival. The outcomes were consistent with the eight-year results from the ENGAGE OUS Registry, published in January 2022, which demonstrated the long-term clinical safety and effectiveness of the Endurant Stent Graft System.

production of the Nellix EVAS system, based on reportedly higher rates of leaks around the device’s implantation, endograft migration and aneurysm sac enlargement. The guideline committee recognized, however, that there was no clear guidance on surveillance and management of patients who have already undergone AAA repair with an EVAS device. It was for this reason that the ESVS AAA guidelines writing committee initiated a literature review on the topic. “The current accumulated knowledge suggests that patients treated with EVAS for AAA may be at high risk for serious aortic-related adverse events, which justified an updated guidance on the surveillance and management of patients already treated with EVAS,” they write in the new paper. Commenting on the timing of the alert, the committee note that they decided it was important to publish before the fully updated guidelines will be available in 2024, “to highlight the issues with EVAS failure, to promote patient safety and to encourage clinicians to identify all patients in whom a Nellix device has been implanted.”