EVTM Symposium 2017 Documentation
The historic first EVTM Symposium in Örebro february 2017 initiated continous knowledge sharing on the fast developing endovascular and hybrid techniques for bleeding and trauma management.
Chairs: T. Hörer (Vascular;SE) and A. Pirouzram (Vascular;SE)
- Opening remarks – Tal Hörer – Symposium Chair (SE) Göran Wallin, Lars Norgren, Mathias Sandin and the Örebro regional director (SE)
- Key Note Lecture: Military & civilian advances in trauma care – K. Boffard (Trauma;SA) Q&A
- Key Note Lecture: REBOA and modern trauma care – T. Rasmussen (Trauma/Vascular;US) Q&A
- Key Note Lecture: Time for paradigm shift in hemorrhage control: What can we learn from the past – T. Larzon (Vascular;SE) Q&A
- Endo techniques in hemorrhage; Role of IR – T. Vogl (IR;DE) Q&A
- Russian experience: vascular trauma from Afghanistan ’79 onwards – Where and how endo/hybrid can be used? – I. Samokhvalov (Trauma/Vascular;RU) Q&A
- Experience with REBOA/ABO in rAAA & lessons – How can endo/vascular surgeon help in bleeders? – B. Starnes (Vascular;US) Q&A
Opening Session 2
- Aortic injuries USA data and the Aortic Trauma Foundation – J. DuBose (Trauma/Vascular;US) Q&A
- JEVTM – launching of a new platform – J. Morrison (Editor) (Trauma/Vascular;UK)
- The UK-REBOA Trial – J. Jansen (Trauma/ICU;UK)
- Round table REBOA USA ”vs” ABO Japan – Past/present/future in Japan & USA – Led by J. Morrison (Trauma/Vascular;UK) and L. Handolin (Trauma;FI)
Panel USA: C. Fox (Vascular;US), M. Hoehn (Vascular/Trauma;US), T. Rasmussen (Trauma/Vascular;US), T. Williams (Vascular;US), B. Starnes (Vascular;US), J. Love (Trauma, US)
Panel Japan: K. Idoguchi (Trauma/Vascular;JP), Y. Kon (ED/IR;JP), F. Kashimi (ED/IR;JP), J. Matsumoto (IR;JP), Y. Matsumura (IR;JP/US), T. Orita (IR;JP)
- EVTM and REBOA – Civilian and military applications; Panel discussion and Q&A Led by J. DuBose (Trauma/Vascular;US) and V. Reva (Trauma/Vascular;RU)
Panel: P. Talving (Trauma;EE), O. Merin (Trauma;IL), L. Riddez (Trauma;SE), S. Cacala (Trauma; ZA), L. Hile (ED;US), J. Manning (ED;US), J. Tisnado (IR;US), P. Vassiliu (Trauma;GR), S. Spiliopoulos (IR;GR), C. Wahlgren (Vascular;SE), K. Boffard (Trauma;ZA), J.Love (Trauma;US)
Session 1 Part 1 – EVTM and multidisciplinary approach
Session 1 Part 2 – EVTM and multidisciplinary approach
Chairs: J. Matsumoto (IR;JP) and G. Oosthuizen (Trauma;ZA)
- Endovascular bleeding control and multidisciplinary approach in Stockholm – C. Wahlgren (Vascular;SE)
- Endovascular bleeding control by Interventional Radiology (IR) in the USA; What can we do? Examples – J. Tisnado (IR;US)
- IR in trauma & bleeding in Sweden – Where can we help and how? – M. Delle (IR;SE) and M. Falkenberg (IR/Vascular;SE)
- Japanese experience – the IR view of multidisciplinary approach in trauma/bleeders – J. Matsumoto (IR;JP)
- When to use endo techniques in trauma? Which patient? Who should do it? Any evidence? – J. Love (Trauma;US)
- Is EVTM relevant in South Africa? First REBOA experience in South Africa – G. Oosthuizen (Trauma;ZA)
- Endo trauma experience at the Shock Trauma Centre in Baltimore – when and how to use the hybrid room? – M. Hoehn (Vascular/Trauma;US)
- WSES guidelines for pelvic bleeding, including REBOA? – F. Coccolini (Trauma;IT)
- Panel and audience discussion: Multidisciplinary approach in bleeders. EVTM. When?
Session 2 – Vascular access in bleeding & trauma patients
Chairs: T. Larzon (Vascular;SE) and T. Vogl (IR;DE)
- The rational for vascular access for bleeding control – the benefits, risks and complications – Z. Rancic (Vascular;CH)
- Tips & tricks for vascular access in bleeders; access in the elderly population – J. Holst (Vascular;SE)
- Pitfalls in vascular access; What can go wrong? – A. Pirouzram (Vascular;SE)
- Vascular access in the ER in Japan – experience and evidence (Direct IABO registry) – Y. Matsumura (IR;JP/US)
- Vascular access in austere environment and/or in the field for bleeders – V. Reva (Trauma/Vascular;RU)
- Vascular access in unstable patients – tips & tricks – M. Malina (Vascular;SE/UK)
- Vascular access and closing techniques; The vascular surgeon point of view – D. Eefting (Vascular;NL)
- Large bore access complications – What you should know and recent data – M. Taudorf (IR;DK)
- Debate: PRO vascular access already on arrival during primary survey – B. Starnes (Vascular;US)
- Debate: CON Vascular access only if needed in major bleeders – C. Wahlgren (Vascular;SE)
- Panel and audience discussion: About vascular access for bleeders, timing, contraindications and how to do
Tokai Lunch Symposium – Trends in Trauma
Chair: Lauri Handolin, MD, PhD, Trauma Unit, Helsinki University Hospital
- 1. U.S. and Japan – Yosuke Matsumura, MD, PhD, R Adams Cowley Shock Trauma Center, University of Maryland
- 2. South Korea – Sung Wook Chang, MD, PhD, Trauma Center, Dankook University Hospital
- 3. Israel – Michael Stein, MD, Rabin Medical Center – Beilinson Hospital
Session 3: REBOA
Chairs: T. Rasmussen (Trauma/Vascular;US) and J. DuBose (Trauma/Vascular;US)
- REBOA: is there any data? – J. Morrison (Trauma/Vascular;UK)
- REBOA Europe – ABOTrauma Registry and pREBOA data – K. Nilsson (ICU;SE), M. Sadeghi (Surgery;SE) and T. Hörer (Vascular/ICU; SE)
- REBOA Japan DIRECT data – Y. Matsumura (IR;JP/US)
- REBOA USA – AORTA study and nomenclature of REBOA – J. DuBose (Trauma/Vascular;US)
- REBOA – the Houston Texas experience; Lessons; Exemples – L. Moore (Trauma;US)
- Use of REBOA in the USA military; First experience report – J. DuBose (Trauma/Vascular;US)
- First REBOA experience in Israel – B. Kessel (Trauma;IL) and D. Hebron (Trauma/IR;IL)
- Italian preliminary REBOA experience; Report from two level I trauma centers – E. Gamberini (Trauma;IT)
- REBOA Italian survery – M. Zago (Trauma;IT)
- Debate: REBOA in penetrating trauma – Evidence or gut feeling? My thoughts – G. Oosthuizen (Trauma;ZA)
- Debate: REBOA in blunt trauma – Evidence or gut feeling? My thoughts – O. Merin (Trauma;IL)
- Panel and audience discussion: Total and partial REBOA, Transfer REBOA – options? Tips & tricks/how to do? Not to do?
Session 4: Pre-hospital and military REBOA
Chairs: J. DuBose (Trauma/Vascular;US) and T. Rasmussen (Trauma/Vascular;US)
- The rationale for pre-hospital REBOA in London – Z. Perkins (Trauma;UK)
- Pre-hospital REBOA – The London experience & lessons – S. Sadek (ED;UK)
- Prehospital and transfer REBOA in Japan – preliminary experience – K. Idoguchi (Trauma/Vascular;JP)
- Transfer military REBOA (animal) first experience and the lessons learned – V. Reva (Trauma/Vascular;RU)
- Military aspects of hemorrhage control and REBOA: How far forward to push technology? – T. Rasmussen (Trauma/Vascular;US)
- Combat related vascular injuries: What about EVTM and REBOA? – R. Hoencamp (Vascular/Trauma;NL)
- Debate: PRO REBOA can be used in the field – J. Morrsion (Trauma/Vascular;UK)
- Debate: CON REBOA should not be used in pre-hospital settings – J. Love (Trauma;US)
- Panel and audience discussion: REBOA in pre-hospital senarios – When and how? Transfer REBOA?
- Consensus on REBOA? – J. DuBose (Trauma/Vascular;US) and B. Kessel (Trauma;IL)
Session 5: REBOA 2 and more on EVTM
Chairs: L. Handolin (Trauma;FI) and B. Kessel (Trauma;IL)
- REBOA use in exsanguinating pelvic trauma – C. Fox (Vascular;US)
- REBOA and embolization in pelvic injuries – The Baltimore experience & lessons – M. Hoehn (Vascular/Trauma;US)
- REBOA in rAAA under local anaesthesia – results and the implications for trauma? – P. Vriens (Vascular;NL)
- More Japanese experience with REBOA and EVTM; Cases – K. Idoguchi (Trauma/Vascular;JP)
- Visceral organ embolization in hemorrhage (Trauma, GI, PPH) – which embolization agents (liquids? coils? plugs?) – M. Delle (IR;SE)
- Data on great vessels and endografts in trauma – any evidence? – J. Love (Trauma;US) and J. DuBose (Trauma/Vascular;US)
- Great vessels endografts – what can be used in bleeders? – P. Vriens (Vascular;NL)
- Debate: PRO: Endo tools should be used in major bleeders! – C. Fox (Vascular;US)
- Debate: CON: Bleeding control the good old way – open it! – P. Talving (Trauma;EE)
- Panel and audience discussion: REBOA, embolization and endografts in bleeders
Session 6: Who should do REBOA and training issues
Chairs: G. Oosthuizen (Trauma;ZA) and L. Handolin (Trauma;FI)
- US BEST courses – M. Hoehn (Vascular/Trauma;US)
- EVTM workshops Sweden; how to train on EVTM/REBOA, pREBOA, iREBOA – A. Pirouzram (Vascular;SE) and T. Hörer (Vascular; SE)
- Japanese REBOA DIRECT courses – T. Funabiki (IR;JP)
- From training to using REBOA in the ER – How to think, how to train. New courses – Z. Qasim (ED;US)
- REBOA training methods on animals, simulator and more. Lessons from Copenhagen – L. Lönn (IR;DK)
- Training on cadaver and live tissue vs simulators – K. Inaba (Trauma;US)
- Debate: PRO REBOA should be done by trauma surgeons – J. Love (Trauma;US)
- Debate: CON REBOA should be done by emergency doctor – L. Hile (ED;US)
- Panel and audience discussion: REBOA/EVTM training/teaching; Who should do REBOA?
Session 7: Translational, clinical research and new technologies
This session can only be watched on Youtube, because of an unknown Facebook error.
Chairs: J. Morrison (Trauma/Vascular;UK) and T. Rasmussen (Trauma/Vascular;US)
- REBOA in other bleeders (PPH and more) – Norwegian experience and review – E. Søvik (IR;NO)
- pREBOA Animal data (SW) – K. Nilsson (ICU;SE), M. Sadeghi (Surgeon;SE) and T. Hörer (Vascular; SE)
- Animal Studies REBOA – A. Johnson (Trauma;US)
- Data on small sheath REBOA Japan – Y. Matsumura (IR;JP/US)
- Emerging technologies in EVTM and REBOA: Next steps (US) – T. Williams (Vascular;US)
- New techniques & technology for access closure – T. Larzon (Vascular;SE)
- New endo technologies and endografts – V. Riambau (Vascular; ES)
- Clinical trial design for clinically complex and rare interventions – J. Jansen (Trauma/ICU;UK)
- Selective aortic arch perfusion (SAAP) – Relevant for trauma and bleeding? – J. Manning (ED;US)
- IVUS guided REBOA – Confirming delivery & effect – P. Rees (Trauma;UK)
- REBOA in trauma in youth – T. Norii (ED;USA)
- Panel and audience discussion: New bleeding technologies for hospital, pre-hospital, military enviroment
Session 8: Anesthisiological and ICU aspects of EVTM, REBOA and complications
Chairs: J. DuBose (Trauma/Vascular;US) and K. Inaba (Trauma;US)
- Vascular access complications – what is relevant to post-operative management? Cases – M. Falkenberg (IR/Vascular; SE)
- Special anesthesia concerns when utilizing REBOA – R. Lendrum (ICU;UK)
- Molecular basis for reperfusion injury and strategies to ameiorate cellular dysfunction – J. Morrsion (Trauma/Vascular;UK)
- REBOA related issues in the ICU: an evidence free zone? – J. Jansen (Trauma/ICU;UK)
- Abdominal compartment syndrome and other complications relevant for REBOA – P. Skoog (Vascular;SE)
- Reperfusion injury after REBOA – how to mitigate the risk in the OR – R. Lendrum (ICU;UK)
- REBOA complications – cases – V. Reva (Trauma/Vascular;RU)
- Panel and audience discussion: The anesthetist and ICU point of view; what can we optimize?
- Closing remarks – Next EVTM symposium 2018, The EVTM society, JEVTM and future aspects – Tal Hörer – Symposium Chair
Information before EVTM17:
-More than 350 medical professions and 24 companies will be there.
-Abstract submission closed. Very exciting data is comming in and some will be presented in oral presenation.
-First report on the initial pre-hospital REBOA experience in military settings (USA)
-First REBOA data from Israel, South Africa, Italy and more will be presented.
-The faculty have confirmed – the majority of groups using REBOA will be represented!
-Worldwide experts practicing and developing REBOA as well as other EVTM methods will share their knowledge, experiences and update on current status.
-Many experienced surgeons, IR, vascular surgeons and ICU people will be there. It not only REBOA, but using new techniques for bleeding control.
-It’s a new concept: short presentations and up-to-dates as well as time for discussions and debates. A good oppurtunity to be active in these discussions as this will be an open forum. Come an join an active forum for discussions!
Some words on EVTM:
As endovascular methods develop, they can be incorporated into initial trauma care upon patients arrival. This includes adopting a multidisciplinary team approach, early femoral vascular access (AABCDE), Aortic Balloon Occlusion (ABO or REBOA), surgery on a sliding/angiography table, angiography, embolization, stent grafts and much more. We can use both open surgery and endo methods (hybrid) to control massive bleeding by having an EVTM approach at time of patients arrival or even in the field or battlefield (pre-hospital). Some of these methods have been in use for decades while some have been developed over the last 10 years. However, not all are used in primary trauma or bleeding management but techniques are under development. EVTM can also be used in other bleeders as PPH, GI, iatrogenic.
We believe that the EVTM concept is here to stay and should be applied in all severe trauma cases, even in the pre-hospital environment and battlefield. EVTM can be used in both developed and less developed countries, with an old C-arm or in a modern hybrid suite.
There are also some brand new developments in EVTM regarding REBOA including partial REBOA (pREBOA) vs total REBOA (tREBOA), intermitted REBOA (iREBOA), field REBOA (fREBOA), deflated REBOA (dREBOA) or transfer REBOA – Very exciting times!
-In cooperation with Tokai (Rescue Balloon), Cook Medical, GORE, Philips, Prytime (ER-REBOA), 3Dimprigo, BBraun, Toshiba, Bolton and other companies, Örebro regional council, Örebro research council, Örebro University Hospital. Finnish trauma Society, Italian trauma society, DIRECT (Japan), Russia surgical and vascular societies, Seldinger society, Swedish society of aneasthesia and intensive care, Brazilian vascular and surgical societies, Netherlands emergency doctor’s association. Swedish Seldiner society (IR), South Africa trauma association and others are partners in this venture!
-The EVTM symposium received EU accreditation (CME point system)- EACCME
- “Top Stent Manual” to be launched in the symposium and will be distributed free of charge to all participants. It’s being printed now!
- Launch of the JEVTM (the Journal) and EVTM society planned!
- New medical products will be launched (Rescue Balloon, ER REBOA and others)
- Stent-grafts, embolization agents and other products
- New exciting data, first REBOA experience and data (human and animal studies)
–Some of the exciting issues in the symposium:
USA REBOA vs JAPAN REBOA: Head to head discussion on how to do REBOA, indications and tips
Up-to-date: What do we know on REBOA by now? When to use and how?
Up-to-date: First report on modern battlefield REBOA cases!
Usage of Endovascular technologies in bleeding- endografts, embolization and more.
Major vessels and embolization
REBOA for non-trauma (PPH, GI bleeding and more)
And much more!
Who should do REBOA and where? Indications?
pREBOA, iREBOA, transfer and field REBOA? Report on first experimental transfer REBOA
REBOA for penetrating or/and blunt injuries? When NOT to use REBOA?
Vascular access already on admission?
Open or Endo in trauma? When and how?
Multidisciplinary approach in trauma patients?
Timing of endovascular and hybrid procedures; Exfix/preperitoneal packing first in pelvic bleeding?
REBOA- Data, experimental issues
New data on pREBOA, Multi-centre studies (ABOTrauma Registry, AORTA, IABO-DIRECT)
Stent grafts for major vessels trauma, current data. Blunt Aorta Injuries
Embolization for bleeding, current data
New Endo and hybrid technologies
Faculty EVTM 2017:
The speakers and panellists will include enthusiastic people: trauma, vascular, interventional radiologists, military, ER and ICU professionals and teams working with these issues. List of the faculty is below:
|Stravis Spiliopoulos (GR)||Rickard Lindgren (SE)|
|Shas Cacala (SA)||Joe Love (USA)|
|Gareth Davies (UK)||Lars Lönn (DK) (TBA)|
|Bijan Darvish (SE)||Yosuke Matsamura (JP)|
|Martin Delle (SE)||Junichi Matsumoto (JP)|
|Marko Dragas (SR)||Jonny Morrison (UK)|
|Josef Dubose (USA)||Louis Riddez (SW)|
|Daniël Eefting (NL)||Kristofer Nilsson (SE)|
|Mårten Falkenberg (SE)||George Oosthuzien (SA)|
|Gareth Greir (UK)||Kennet Boffard (SA)|
|Ali Hallal (LB)||Zane Perkins (UK)|
|Lauri Handolin (FIN)||Artai Pirouzram (SE)|
|Dan Hebron (IS)||Zaffer Qasim (USA)|
|Patrick Vriens (NL)||Zoran Rancic (CH)|
|Seppo Hiippala (FIN)||Todd Rasmussen (US)|
|Lisa Hile (USA)||Viktor Reva (RU)|
|Melanie Hoehn (USA)||Shahin Mohseni (SE)|
|Rigo Hoencamp (NL)||Samy Sadek (UK)|
|Jan Holst (SE)||Joao Sahagoff (BR)|
|Tal Hörer (SE)||Mathias Sandin (SE)|
|Kodji Idoguchi (JP)||Per Skoog (SE)|
|Kenji Inaba (USA)||Benjamin Starnes (USA)|
|Jan Jansen (UK)||Edmund Sövik (NO)|
|Michael Johanson (USA)||Martin Malina (SE, UK)|
|Boris Kessel (IL)||Mauro Sago (IT)|
|David King (USA)||Pantelis Vassiliu (GR)|
|Yuri Kon (JP)||Thomas Vogl (GE)|
|Thomas Larzon (SE)||Carl Wahlgren (SE)|
|Robbie Lendrum (UK)||Göran Wallin (SE)|
|Peep Talving (ES)
Igor Samokhvalov (RU)
Laura Moore (USA)
Charles Fox (USA)
Jaime Tisnado (USA)
Eitan Heldenberg (IL)
Tim Williams (US)
Vincent Riambau (SP)
Tal Hörer (Chair), Rickard Lindgren, Göran Wallin, Artai Pirouzram, Mathias Sandin, Kristofer Nilsson, Johan Josefsson, Jonas Berlin, Monica Clomen, Mitra Sadeghi, Thomas Larzon, Chatarina Lindahl, Åsa Strandberg, Shahin Mohseni, Kjell Ågren and Olle Ljungqvist.
In cooperation with the Örebro medical students surgical society.
End of the EVTM 2017 Symposium