Forecasting their Charing Cross (CX) 2024 venous programme highlights, executive board members Manj Gohel (London, United Kingdom), Erin Murphy (Charlotte, USA) and Stephen Black (London, United Kingdom) discuss the “exciting” controversies and debates, first data releases and a “much expanded” workshop programme bringing cutting-edge technology straight from the podium into practice.
“The theme of this year is controversies, and it is just as well because there seems to be a never-ending supply of controversial and debated areas in the venous space,” Manj details. He explains that a key area housed in controversy will be appropriate care, as, with the “explosion of technologies” today he believes there has been a “real tendency to overtreat some pathologies”, which the co-chairs seek to address. On this topic, he expands that international speakers will gather to discuss the broad variations of venous disease to “help the CX audience understand what the solid indications and foundations are for treating these pathologies”, he continues.
Adding to this, Black brings awareness to the realisation that deep venous disease has “expanded”, which has raised the “issue” of appropriateness, agreeing with Gohel. The CX 2024 programme, he asserts, will address how treating a group of patients that are “much younger than their arterial contemporaries that we are normally familiar with” will expand on the “controversy” surrounding how a stent can remain patent for 40–50 years, delivering clinical benefit to the patient throughout that period.
“We are looking at concepts of stent maintenance, of in-stent restenosis, how to keep stents open, how to better select patients, how to deal with in-flow—all the adjunctive techniques that we start to need to make a difference to patients today. That is what I am really enthused about and hope we can start stirring some discussion about,” says Black.
For Murphy, the “willingness” of the selected CX faculty to engage in discussion about these current challenges “head on” is what sets the symposium apart and will be reflected in the debates that are set to take place in 2024. “CX has been amazing for so many reasons—the debates are one of my favourite areas,” she notes.
CX 2024 will also continue to be a space for first data releases; Murphy draws attention to new data which will be emerging from areas such as venous valve creation and pulmonary embolism, including a trial for pelvic venous congestion—a “controversial” area lacking data to date on which “exciting” recent work will be presented at the Excel centre.
On the topic of data releases, Gohel expects that the superficial venous programme will expand on the role of non-thermal modalities, particularly cyanoacrylate glue, via the VenaSeal spectrum study. Murphy notes that theirs is one of the largest randomised trials in the superficial space, concluding with Gohel who states that the release of this data at CX 2024 will provide a “solid foundation that is needed to build practice going forward”.
According to Black, clot management will also pull focus in the venous programme, due to the growing range of devices that are available today. Considering thrombotic devices, he notes that there has been a “big move away” from lytic toward mechanical thrombectomy only, noting that this is only partially driven by data. “There is absolutely good evidence out there from companies who have committed to randomised controlled trials”, which the speakers will bring to the CX audience next year.
Aiming to push boundaries and interrogate best practice, another key focus at CX 2024 will be lively debate. Gohel hints at discussions which will compare whether or not there is adequate evidence to support intervention of non-thrombotic iliac vein lesions as an “exciting” area on the programme.
“This has really been an area where we have seen the greatest explosion of interventions around the world, particularly in the USA, and I think we sometimes need to just make sure the evidence supports the aggression and the strength of intervention. So, we are going to plan some really lively, interesting debates for that one and looking forward to that for sure”.
Appraising the location of CX 2024, Gohel reflects that the Excel will provide a “much expanded and exciting workshop programme” for venous, including expert case presentations and interactions, and will enable the audience to supplement what they see on the podium and try out novel devices.
Wrapping up, Murphy reflects on the legacy left by recently passed Professor Roger M Greenhalgh, internationally renowned vascular surgeon and founder of the Charing Cross series of international symposia—“he was a legend and an inspiration and I hope we can make him proud this year. I believe that the programme we are coming up with will do that, and I hope people will join us at CX 2024”.
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