The 5th annual AMPutation Prevention Symposium was held in Chicago on August 12-15, 2015. This year’s record attendance included nearly 800 participants from 42 states and 19 countries, representing the nation’s largest gathering of clinicians dedicated to preventing unnecessary amputations due to critical limb ischemia (CLI). Attendees included those involved with peripheral vascular interventions: vascular and general surgeons, interventional and general cardiologists, primary care physicians, interventional radiologists, podiatrists, wound care specialists, nurses, vascular technicians, and cardiac cath technologists. Attendees interact with the world’s most respected leaders and pioneers in CLI therapy and gain knowledge and strategies to help prevent lower limb amputations in patients.
As the nation’s only medical conference focused on preventing lower limb amputation in patients with CLI, AMP 2015 featured leading CLI experts, four days of high-level education, hands-on workshops, tools and technologies used for access, intervention, and closure of CLI cases.
The AMP Symposium was born due to an unmet need for education and technologies to address the critical health issue of CLI. AMP gives physicians the opportunity to share strategies with the very best minds in this field, embrace innovation, and learn about the vital role emerging therapies play in preventing amputations. It has become my personal mission to see amputations due to CLI drastically reduced across this country and across the world. I want every physician focused on techniques to save limbs, because we hold the utmost responsibility to care for patients with this very serious disease, and help improve and extend their lives.
Professor Thomas Zeller, MD, gave this year’s keynote address. Professor Zeller is an interventional cardiologist and Director of the Department of Angiology at Universitaets-Herzzentrum Freiburg-Bad Krozingen, Germany. Professor Zeller, who is an AMP Course Co-Director, shared a global perspective on the latest advances, devices and therapies for critical limb ischemia in his keynote, “Historical Perspective on the Evolution of DCB Therapy: Is the DCB the Holy Grail for CLI Therapy?” When not treating patients in Bad Krozingen, Zeller travels the world speaking and sharing his expertise on the latest advances in endovascular therapy for peripheral artery disease.
Professor Zeller is widely published in the peripheral vascular literature and has served as principal investigator on many clinical trials studying vascular therapy devices, including IN.PACT DEEP, IN.PACT SFA, LEVANT2, BIOLUX P-1, VIASTAR, and DEFINITIVE LE, among others.
Conference education highlights included contributions from nearly 100 faculty, including CLI thought leaders Thomas Davis, MD, Lawrence Garcia, MD, Michael R. Jaff, DO, Krishna J. Rocha Singh, MD, Vlad Alexandrescu, MD, Renu Virmani, MD, Robert Beasley, MD, Marianne Brodmann, MD, Ramon Varcoe, MD, Mariano Palena, MD, William Hiatt, MD, Constantino Pena, MD, Osamu Iida, MD, Lanfroi Graziani, MD, Aljoscha Rastan, MD, Sven Bräunlich, MD, and Lewis Schwarz, MD.
Live CLI cases
The high complexity of treating CLI cases was evident during the challenging cases presented this year via video-stream during breakfast and lunch symposia, as expert faculty panels offered discussion and exchange.
Live CLI cases from day one were performed by D. Chris Metzger, MD, from Kingsport, Tenn. His cases included alternative access and low-profile orbital atherectomy in a patient with severe claudication and a non-healing ulcer. He also demonstrated ultrasound-assisted access and treatment of a complex calcified superficial femoral artery/popliteal lesion utilizing the Supera stent (Abbott Vascular).
Day two cases were performed by Mehdi Shishehbor, DO, MPH, PhD, from the Cleveland Clinic in Cleveland, Ohio. Dr. Shishehbor demonstrated directional atherectomy followed by an IN.PACT Admiral drug-coated balloon (Medtronic) in a patient with Rutherford Class V, multi-level, multi-vessel disease. His second case demonstrated vessel prep and percutaneous transluminal angioplasty followed by Bard Lutonix drug-coated balloon treatment.
George Adams, MD, and AMP Course Co-Director, presented cases from Rex Healthcare and University of North Carolina Health Systems in Raleigh, North Carolina. Dr. Adams demonstrated utilization of the proper crossing tool for the long, complex, multi-level calcified chronic total occlusion followed by orbital atherectomy and a drug-coated balloon. He also demonstrated proper vessel preparation and balloon-to-vessel ratio sizing prior to deployment of the Bard Lutonix drug-coated balloon.
Atherectomy Summit and Hands-On Workshops
The Atherectomy Summit at AMP saw record attendance this year. The Summit was filled with pre-recorded case examples of laser, directional, aspiration, orbital, rotational, and excisional atherectomy. Dr. George Adams spoke on the importance of proper device choice and preparation of the CLI vessel prior to revascularization. The use of ultrasound during CLI cases was discussed and tibial mapping on a live model was demonstrated during the general session.
The Ultrasound-Guided Tibial Pedal Mapping Workshop with Live Models, directed by Matthew W. Sevensma, DO, allowed physicians the opportunity to practice tibial mapping and learn to apply tibiopedal mapping to challenges and obstacles seen in their own practices.
The Ultrasound-Guided Tibiopedal Access Workshop with Cadaveric Models gave attendees the opportunity to attempt tibiopedal access and gain experience utilizing the hockey stick ultrasound probe. Robert Vorhies, MD, a board-certified vascular and endovascular surgeon with Cox Health Systems, Springfield, Missouri, and AMP faculty member, observed, “The cadaver lab is a phenomenal opportunity for attendees to improve their abilities without placing their patients at risk while they learn. It gives them the ability to focus completely on scrutiny, sedation management, and so on.” He added, “It also gives the attendee confidence to implement this technique into their practice on day one when they return home.”
The Atherectomy Workshop, led by Larry J. Diaz-Sandoval, MD allowed physicians to gain hands-on experience with all types of atherectomy. Attendees learned mechanisms of action and decision making in order to select atherectomy devices based on lesion morphology.
New this year was a Complex Lesion Workshop, led by Fadi Saab, MD. Physicians learned device tips and tricks to enhance successful crossing of complex CLI lesions.
Multidisciplinary approach to CLI
AMP 2015 was co-located with the annual meetings of the Save A Leg, Save A Life Foundation (SALSAL) and the American College of Clinical Wound Specialists (ACCWS). A multidisciplinary approach has become a part of our everyday practice. We want the attendees to understand what happens before, during and after revascularization.
“The addition of the SALSAL track along with the traditional AMP track makes this a multidisciplinary conference supporting the goal of limb preservation,” says Charles Andersen, MD, FACS, from Madigan Army Medical Center. “The combination allows attendees to gain up-to-date knowledge and techniques needed to support a multidisciplinary approach in preventing amputations and restoring function. This appeals not only to vascular interventionalists, but also to podiatric surgeons and wound care specialists.”
Donald E. Mrdjenovich, DPM, CWS, FACCWS, from Central PA Podiatry Associates, stated, “The AMP meeting is on the cutting edge of educating providers with current concepts. This year, adding a wound track only further enhances that cutting-edge, forward thinking.”
The Path to AMPutation Prevention
The final day of the meeting concluded with a session that summed up where CLI is today, a summary of CLI data, and what is beyond CLI revascularization to ensure amputation. n
Next year’s AMP Symposium will be held August 10-13, 2016 in Chicago, Illinois.