CX audience demands urgent action on quicker diagnosis of hurting legs

Clockwise from top left: Roger Greenhalgh (London, UK); Andrew Holden (Auckland, New Zealand); Thomas Zeller (Bad Krozingen, Germany); Jos van den Berg (Lugano, Switzerland); and Barry Katzen (Miami, USA).

There is a global crisis, also playing out in developed Western countries, in which too many people are having unnecessary amputations, so losing their limbs, or at risk of pulmonary embolism and death due to missed superficial or deep venous thrombosis. There is, therefore, an urgent need to address the underdiagnosis and undertreatment of hurting legs in order to save life and limb. This was the key message of an inaugural programme on “The Hurting Leg” at the Charing Cross (CX) 2021 Digital Edition (19–22 April, online), where an overwhelming 97% of CX viewers voted that “we must do more and quicker for the diagnosis of the hurting leg”.

Expert discussion at the session considered why neglected causes—both venous and arterial—are being found far too late and treated too slowly, and focused on what needs to be done on this pressing issue.

All sessions on The Hurting Leg are available to view on demand. Click here to register and access the recordings.

“Great unmet need worldwide”

The importance of socioeconomic and geographical factors came to the forefront. In a presentation on reducing time to treatment for patients with chronic limb-threatening ischaemia (CLTI) during the COVID-19 pandemic, James Morris (Preston, UK) highlighted that many patients can live far away from diagnostic facilities and that localisation of services can speed up the time from referral to treatment. Barry Katzen (Miami, USA) noted that the speed at which a patient can see a specialist for a hurting leg is also too slow in the USA, and Thomas Zeller (Bad Krozingen, Germany) echoed that the situation in Germany was similar.

Registrants can view James Morris’ presentation on demand here.

In a roundtable discussion with the CLI Global Society, Barry Katzen stressed that undiagnosed superficial or deep venous thrombosis carries the risk of pulmonary embolism and death, and so must be diagnosed rapidly. He also noted that, “in many parts of the world, the most common vascular procedure is an amputation”. There is a “great unmet need worldwide” for quicker diagnosis and treatment, he remarked.

Registrants can view this roundtable on demand here.

A major issue: “Time is tissue”

A second roundtable spotlighted the diabetologist, vascular surgeon, and interventional radiologist perspectives. Speakers and panellists stressed the importance of increasing awareness, proper imaging, and a multidisciplinary team. Emphasising also the significance of early and accurate diagnosis, Michael Edmonds (London, UK) stressed: “Time is tissue”.

Registrants can view this roundtable on demand here.

Deep venous arterialisation takes centrestage

In a session on novel technology controversies, Peter Schneider (San Francisco, USA) presented outcomes of early trials on deep venous arterialisation. He detailed that results of the PROMISE I study and analysis of ALPS registry data show similar results at 12 months, with limb salvage for patients with “no-option” revascularisation achievable in 77% of patients. “Lessons from these initial trials help to guide therapy development,” he commented. Andrew Holden (Auckland, New Zealand) also addressed deep vein arterialisation, presenting an edited case of the procedure using the LimFlow system (LimFlow).

Seeking audience opinion on deep venous arterialisation, polling revealed that 71% of the CX audience believe in this novel technology.

Registrants can view this session on demand here.


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