ࡱ> "% !_ bjbj 8r=\r=\s*v v 8:><V8zzzzz7777777$8:<77zz48N"N"N"rzz7N"7N"N"90hQ1z*lE !07&80V80=!= Q1Q1=Q5pN"77N"V8=v > : Thursday, 12 November 2015 0830-0900Workshop Registration open0900-1600Pre-Conference Leadership Workshop [Sponsored by Coloplast] 1600-1800Conference Registration Desk open 1700-1730Cadaver Workshop Registration open1730-1900Cadaver Workshop at Adelaide University Medical School Friday, 13 November 2015 0730-0830Conference Registration Desk open0830-0840Housekeeping and Welcome0840-0900Welcome to Country Karen Redman | Lord Mayor Gawler 0900-0930Invited Speaker | The importance of the interdisciplinary team Melissa Noonan | Executive Officer Limbs 4 Life0930-1030Plenary Session 1: Interdisciplinary and Lifestyle Session Chair: Melissa Noonan and Ereena Torpey0930-0940Abstract 72025: Occupational Delay vs Occupational Engagement: 3 case examples of the amputee journey through the Central Adelaide Local Health Network Hannah Bowley | Occupational Therapist, CALHN In 2014 an interdisciplinary Clinicians Leading Care project group was established focusing on decreasing length of stay (LOS) in rehab for amputees. The group found that 3 of the significant impacts on LOS in rehab for amputees identified were; - Time to RRD - Waiting for equipment - Waiting for home modifications Considering this; the recommendations stated in the Model of Amputee Rehab in South Australia and the Brunel University Evidence-based guidelines for Occupational Therapy with people who have had lower limb amputations it was decided, for a short term trial, to increase OT FTE on the Vascular ward at The Queen Elizabeth Hospital, with a specific focus on wheelchair prescription and pressure care management, and early home visits. 3 case examples demonstrate the difference between delayed involvement of Occupational Therapy and early involvement of Occupational Therapy and the impact on patient engagement, expectations, planning for rehab pathway, a return home and ultimately, length of stay.0940-0950Abstract 68965: Low haul air travel and venous thromboembolism Thavenesh Ramachandren | Vascular Trainee, CALHN Introduction: Long haul air travel (>4 hours) causes a significant physiological stress in the older passengers (age 55 to 75). Recognised medical hazards of flying in the geriatric include hypoxia, motion sickness, infections and venous thromboembolism (VTE) such as deep vein thrombosis (DVT) and pulmonary embolism (PE). We discuss the physiological stresses of long haul flights on the elderly population and current preventative measures for VTE. Method: A 'PubMed' and 'Trip database' search was performed using the keywords 'air travel' and 'venous thromboembolism'. Review of the pertinent literature was carried out. Results: Risk of VTE post long haul air travel is 3-12%. It is estimated that 1:250000 passengers over 65 years of age die suddenly from PE during long-distance flights. A specific review of 182 cases of PE, 8 was reported to have been associated with long-distance travel. The cramped seating plan in low cost airlines and prolonged immobility contributes to venous stasis and is a major triggering mechanism for VTE. Compression stockings, aspirin, low molecular weight heparin and prokinase have been used to prevent VTE in the LONFIT studies. Discussion: Venous thromboembolism although uncommon is a serious medical problem especially amongst the elderly travelers. Risk factors for VTE seem to be made worse by the emergence of airline companies that aim to provide a service with the cheapest cost. The incidence of VTE amongst elderly low cost airlines passengers remains unknown and requires further research.0930-1030Plenary Session 1: Interdisciplinary and Lifestyle Session Chair: Melissa Noonan and Ereena Torpey0950-1000Abstract 68685: Acute PE - MET Team in Action Tanghua Chen | CNC, Liverpool Hospital, NSW Pulmonary embolism (PE) is a life-threatening condition which occurs when the blood clot breaks away from a vein and occluding the pulmonary vasculature, right heart failure and cardiac arrest may occur if the condition not been treated promptly and aggressively. A Medical Emergency Team (MET) at the study hospital aims to identify the serious ill patients early to enable intervention taking in place to prevent cardiac arrest. It has been reported that tissue plasminogen activator acts rapidly to lysis the clot in the treatment of acute PE. This study is a retrospective case review of a patient who had a MET call for respiratory distress; Echo demonstrates massive PE with right ventricle dilated. Thrombolytic therapy using tissue plasminogen activator was given during the MET call resuscitation which results in positive patient outcome. This case highlights skills and expertise of the staff & well coordination of the MET team are crucial to this favour outcome, implications for nursing practice will also be addressed.1000-1010Abstract 72077: Diary of a Diabetic; a Verbatim nicola morley | Vascular NP, Gold Coast Pete's plight with Type 1 diabetes and microvascular disease has been narrated in a written paper (as encouraged by his treating health professionals).The paper aims to promote awareness and endeavor to prevent possible catastrophic scenarios of diabetic disease complexities. Pete's verbatim of his personal journey provides a heart-felt narrative of the challenges associated with diabetic health management and the progressive nature of the disease. Pete hopes his message will improve awareness and reduce naivety.1010-1020Abstract 70977: RRD Application: is there a delay in application? A clinical Audit Hannah Keane | Prosthetist, CALHN Rigid Removable Dressing (RRD) application has become common practice following trans-tibial amputation in many health care centres around the world. Research suggests that RRD's reduce stump volume/provide oedema control, promote faster wound healing, and reduced time to prosthetic fitting. Other suggested benefits include protection from external trauma, residuum shaping for prosthetic management, the promotion of skills training - regarding donning and doffing the prosthesis and the desensitization of the residual limb. Within SA Health acute facilities an RRD is to be applied within 24 hours post trans-tibial amputation. It is unknown what percentage of Central Adelaide Local Health Network (CALHN) patients receives an RRD within this timeframe. Currently across CALHN RRDs are applied by a clinical prosthetist. When amputations occur outside of normal business hours the time to apply an RRD is believed to increase. A clinical audit was conducted at The Queen Elizabeth Hospital (TQEH) of all trans-tibial amputations over a six month period. The data was collated and examined to determine areas for improvement in service delivery. Data gathered from this audit is being used to support a future project to determine if a structured RRD training and application program to all staff involved in trans-tibial amputations can decrease the time to RRD application.1020-1030Abstract 68957: Starting Statin Therapy Thavenesh Ramachandren | Vascular Trainee, CALHN Introduction: HMG-CoA reductase inhibitors or 'Statins' are a common group of lipid lowering agents used extensively in vascular risk factor management. The mechanism of action involves competitive inhibition of the HMG-CoA reductase enzyme, the rate limiting step in cholesterol biosynthesis. We present a brief literature review and discussion on starting statin therapy and effects of polypharmacy and medical co-morbidities on the choice and use of statins in patients with dyslipidaemia. Methods: Scientific literature in English was selected through a keyword search in PubMed and Up-to-date. The therapeutic guideline on the CALHN intranet network was reviewed to obtain the latest clinical guideline on statin therapy. The Australian Medicines Handbook was used to obtain the latest dose related information on statin therapy. All information was reviewed and summarised by one reviewer. Discussion: The 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults suggest commencing statin therapy in patients with triglyceride levels of greater than 5.6mmol/L and LDL-C levels of greater than 2.2mmol/L. Rosuvastatin, Atorvastatin and Simvastatin cause the greatest percentage change in LDL-C. Atorvastastin or Fluvastatin are recommended in patients with renal dysfunction. Pravastatin is the statin of choice in patients with liver dysfunction or chronic liver disease. Blood tests including creatinine kinase, thyroid function tests and liver function tests should be checked before commencing statins. Avoid huge amounts of Furanocuoumarin intake when on statins.1030-1115Morning Tea 1115-1300Plenary Session 2: Wound Management and Interdisciplinary and Lifestyle Session Chair: Matt Malone and Nicole Jones1115-1140Invited Speaker | Biofilms and their role chronic wounds: What you need to know as wound care clinicians Matt Malone | Head of Department High Risk Foot Service, Liverpool Hospital NSW 1140-1200Invited Speaker | Improved killing of biofilm with combined topical negative pressure and antiseptics Karen Vickery | Associate Professor, Director Surgical Site Infection Research Group, Macquarie University NSW1200-1220Abstract 69581: Low Frequency Ultrasonic Wound Debridement (LFUD) treatment for clients with non-healing vascular wounds - A report of three cases Tabatha Rando | rdns sa Silver Chain Group Background: Key opinion leaders estimate that at least 25% of chronic wounds treated with gold standard practice do not heal. Biofilm forms in over 60% of chronic wounds and impedes wound healing (James et al. 2008). LFUD has been shown to improve healing by breaking down both slough and biofilm to enhance fibroblast formation (Shannon et al. 2012). Objective: To report on the initial clinical outcomes and client acceptability of the use of LFUD treatment for clients with non-healing wounds. Method: Data were collected from three cases of non-healing vascular wounds as part of the larger client cohort. These clients had multiple co-morbidities and attended the clinic once weekly for 4 weeks to receive LFUD treatment. An advanced wound imaging device was used to collect objective comparable data. Client experience on the device was also obtained. Results: Case 1 - Mixed venous-arterial wound with lymphoedema present for 6 months: healed Case 2 - Chronic venous insufficiency with atrophe blanche present for 6 years: significant size reduction Case 3 - Mixed venous-arterial wound present for 4 months: 5 separate wounds healed To date 19 clients have accessed one or more full courses of this therapy. All but one client has had a reduction in wound size between 25-100% with 4 clients totally healed. Conclusion: The initial results suggest that LFUD has been beneficial for patients with non-healing wounds in the RDNS (SA) Complex Wound Clinic.1220-1240Invited Speaker | Cellutome Epidermal Skin Grafting Case Studies Demonstrating the Clinical Experience Using the Cellutome in an Outpatients Setting. Tina McEvoy | Wound Nurse Practitioner, Nepean Hospital, Penrith, NSW 1240-1300Invited Speaker | Biofilms and infection prevention Karen Vickery | Associate Professor, Director Surgical Site Infection Research Group, Macquarie University NSW1300-1400Lunch1400-1445ANZSVN Annual General Meeting1445-1620Plenary Session 3: Wound Management Session Chair: Rob Fitridge and Vanessa Heinrich1445-1500Invited Speaker Update on the International Diabetic Foot Guidelines Professor Rob Fitridge | Head of Vascular Surgery; Central Adelaide Local Health Network1500-1510Abstract 70985: The diabetic foot: the orthotist's role in offloading Hannah Keane | Prosthetist, CALHN Offloading can often be overlooked as a critical part of wound healing however when used in conjunction with an interdisciplinary diabetic foot team it can produce successful outcomes. Diabetic foot ulcers can be difficult to treat with many co-morbidities and social issues affecting the offloading modalities available. The role of Orthotists within the diabetic foot team is evolving and current offloading techniques are varied and individualised to the patient and wound. Current best practice guidelines and the implementation of these guidelines will be discussed. 1445-1620Plenary Session 3: Wound Management Session Chair: Rob Fitridge and Vanessa Heinrich1510-1520Abstract 71977: Contact Casting: The Challenges and the Conquests Nicola Morley | Vascular NP, Gold Coast Off-loading diabetic plantar foot ulcers to achieve reduction in plantar pressure and improve healing is widely accepted. The varying effectiveness of offloading modalities have been discussed in literature and contact casting has been considered the gold standard. The utilisation of this mode of treatment has been previously limited due to time constraints, skill set and availability. TCC-EZ total contact cast system was trialed within the Vascular Nurse Practitioner Multi-Disciplinary Clinics. This presentation provides a short video along with case analogies which share our challenging experiences and ultimate conquests within the Integrative care environments. Vascular, Podiatry and Orthopaedic teams have embraced this new product technology and are able to demonstrate its ease of use and proficiency within the diabetic plantar ulcer cohort.1520-1530Abstract 70113: The use of Toe Pressures (TP) using the Systoe device in patients with PVD Erika Crowther | ACSC, Vascular Unit, CALHN and Thavenesh Ramachandren | Vascular Trainee, CALHN Introduction: Ankle Brachial Pulse Index has been a major method of vascular assessment using the Doppler device. Patients with diabetes and renal dysfunction, the accuracy of the Doppler device is unreliable due to incompressible calcified arteries. Toe pressures (TP) are a non-invasive procedure and an alternative assessment tool that indicates the arterial blood flow. TP predicts the likelihood of healing in patients with critical limb ischemia and/or ulceration. The RAH Vascular department proposed the use of the SYSTOE device a machine designed to measure the systolic pressure of a digit and/or toe Methods: The SYSTOE was newly introduced to the hospital in 2013, was used to quantitatively assess the blood circulation in patients with diabetes and renal dysfunction. An occlusive cuff and sensor is placed around the hallux or healthy toe (with a healthy pulp). The cuff automatically inflates up to a preset pressure draining the pulp blood then deflating slowly until the pressure in the cuff reaches 10mmHg . The return of arterial inflow to the digit is detected by the sensor and is recorded during deflation of the cuff . The systolic pressure of the toe is then noted by a raise in the acquisition screen on the Systoe device and results are validated. Results: Total of 760 patients were assessed between June 2013 and June 2015 at the Royal Adelaide. Conclusion: We recommend the SYSTOE device as a good alternative assessment tool to predict the likelihood of healing wounds in patients with diabetes and/or renal dysfunction.1530-1540Abstract 68245: Pressure Injury Prevention Naomi March | END Vascular Unit, FMC Background The risk factor for pressure injuries in vascular patients is high. Our surgeries are often complex and require a considerable amount of of bed rest post operatively, leading to an increased risk for pressure injuries. Method A PIP poster was developed in a simple, easy to read format, to better educate staff and patients, it helps staff to grade the severity of the PI, the importance of a balanced diet, how often PAC needs to be performed. Showing clear illustrations and diagrams. It guides our nurses and health professionals to educate our patients, to help us to help them. Result By using the PIP poster in conjunction with our skin assessment tool, staff have been better equipped to confidently grade PI's, by looking at the pictures of the 5 stages of PI's. Feedback from staff has been positive. Staff report, it has been a helpful and useful tool and has been great to know it is there to refer to during a skin/wound assessment. Patient's who can ambulate and have access to the poster, have said it has been helpful for their learning and understanding. Conclusion By educating staff and patient's, we aim to reduce the number of hospital acquired PI's on ward 5a and throughout the hospital at FMC. This poster, has been distributed throughout FMC, and is available for all wards and departments to purchase. Education and prevention is the key! 1445-1620Plenary Session 3: Wound Management Session Chair: Rob Fitridge and Vanessa Heinrich1540-1550Abstract 70973: An integrated approach to healing the challenging wound Nicola Morley | Vascular NP, Gold Coast Methods The increasing level of patient acuity, technological change, and paucity of resources equates to complex wound challenges which require qualified competent personnel to manage and treat them. The following cases represent the difficult challenges of managing wound infection through adequate wound bed preparation, advanced dressing technologies and staff education. Findings Having collaborative care environments positively enhance both patients' healing outcomes, nurse & multidisciplinary team training opportunities. Partnerships improve the overall efficiency of the health care system in terms of reduction in emergent hospital presentations, length of stay, recurrent surgical procedures and antibiotic requirement. Application The impact of integrated care pathways provides a structured uniformity allowing baseline comparison, standardisation of care, audit and optimal timely outcomes between centres. Amalgamating care partnerships across Tertiary and Secondary centres will be influential in meeting the increasing prevalence of difficult chronic wound presentations1550-1600Abstract 71053: Identifying relationships between symptom clusters, biological processes and wound healing Theresa O'Keefe | NUM, Vascular Unit, Brisbane Aim / Purpose: Chronic leg ulcers are associated with multiple disabling symptoms such as pain, fatigue, oedema and inflammation. Traditionally, symptoms have been examined and treated individually. This approach overlooks the combined effect of multiple concurrent or "clustering" symptoms. This project aims to identify the relationships between symptom clusters, biological markers, wound healing and quality of life in adults with chronic leg ulcers. Methods: Patients with predominantly venous leg ulcers are recruited from an outpatient clinic. Data is collected on socio-demographics, health, ulcer characteristics, surrounding tissue characteristics, treatments, progress in healing, symptoms, symptom management, quality of life, and wound exudate for biological analysis for 24 weeks. Factor analysis will be used to identify symptom clusters and classify high and low risk sub-groups. Findings: Recruitment commenced in April 2015. Preliminary analysis of the current sample shows 60% female, 40% live alone, 60% require a walking aid, and 44% have a history of a DVT. Median ulcer duration was 6 years (range 4-1560 weeks). Symptoms at the time of recruitment include 33% with peri-wound inflammation, 87% with heavy wound exudate, a mean pain score of 3.5/10, 50% reported significant sleep disturbance, and 40% scored at risk for depression. Application in Practice Today and Beyond: Results from this study are will identify the impact of symptom clusters on healing and quality of life, to enable early identification of high-risk patients requiring tailored interventions; and improve understanding of symptom clusters and healing outcomes to guide more effective treatments.1600-1625Invited Speaker Wound CRC Update Anthony Dyer | Wound Management and Innovation CRC (Special Projects & Initiatives Director)1625-1630Close of Day1900-2300Conference Dinner with ANZSVN Member Awards [sponsored by Hartmann] Saturday, 14 November 2015 08.30-0900Conference Registration Desk open900-0905Housekeeping and Welcome0905-1100Invited Speaker | How to look after yourself as a clinician Samantha Young | Consultant Psychologist / Director; Broomhall Young Psychology1100-1130Morning Tea1130-1300Plenary Session 4: The Renal Patient | Head - Fistula - Kidney - Toes Session Chair: Sue Monaro and Lucy Stopher1130-1200Abstract 72517 | Patients presenting for Access Creation with Renal Disease and their Choices Kim Torpey | Renal Access CPC, Adelaide The type of patient entering into the dialysis program now has changed from years previous and so too their choices. 35% of all patients commencing dialysis now have Diabetic Nephropathy as their primary disease this along with a co-morbidity prevalence program including 36% coronary vessel disease and 22% with peripheral vascular disease (ANZDATA 2014) for new patients commence Renal Replacement Therapy making renal access construction and maintenance an integrated approach. At Flinders Medical Centre when patient are presented with options of dialysis 30% of patient with End Stage Kidney Disease (ESKD) are choosing not to have dialysis.1200-1230ABSTRACT 73298 | Renal access: Treatment Options and Techniques Dr Ewan Macaulay | Vascular Surgeon, Adelaide The rationale behind and planning of renal access as well as the techniques for placing both autogenous and synthetic fistulas. It will describe how to clinically assess a fistula and recognise problems. It will also describe the treatment of the most common problems encountered with arteriovenous fistulae.1230-1240Abstract 72321: Ultrasound usage at point of contact Pongsuwan Sukhuma| ACSC, Renal Unit FMC Ultrasound usage at the point of contact. Haemodialysis access maintenance is an important dialysis nursing care concern. To improve the care of dialysis patients, the access flow monitor has been performed regularly to detect deterioration in function of arteriovenous fistula (AVF) or arteriovenous graft (AVG). While access flow result is decreasing significantly, ultrasound has been used to find out any stenosis, thrombosis or pseudo aneurysm. For immature, traumatised, swollen AVF or oedema in the AVF arm which is difficult to cannulate, ultrasound has been used as a guide for needling. The ultrasound can show location, direction, depth and the flow of AVF1240-1250Invited Speaker | Ultrasound of AVF: the Good, the Bad and the Ugly Richard Allan | Senior Vascular Scientist, Heart Foundation Scholar, Dept. Vascular and Endovascular Surgery | FMC and Assoc. Lecturer | School of Medicine, Faculty of Medicine, Nursing and Health Sciences, FUSA Autogenous arteriovenous fistulae (AVF) represent the best long-term option for haemodialysis but are prone to complications that require investigation and treatment. Ultrasound assessment of AVF can be in the form of point of care assessment by medical and nursing staff or as a more sophisticated diagnostic tool used by sonographers. This presentation will focus on the latter application. Ultrasound has two distinct roles in AVF management: 1) pre-operative planning and 2) investigation of AVF complications. Ultrasound is the primary imaging modality for AVF assessment because it provides very high resolution images, can measure blood flow characteristics, is non-invasive, and is widely available. Pre-operative planning ultrasound is used to assess suitability of the target artery and vein, and has been shown to significantly reduce failure rates. Post-operatively the most common complications requiring ultrasound assessment are related to inflow stenosis (most commonly in the distal vein close to the anastomosis), outflow stenosis (either central venous or at the cephalic arch vein), trauma in the cannulation zone and steal syndrome. Standard grey-scale ultrasound, colour and pulsed wave Doppler are all utilised to assess an AVF. Diagnosis is a combination of qualitative assessment and the application of specific measurement criteria. In this presentation the technical aspects of fistula sonography will be briefly reviewed and a series of illustrative cases of the most common abnormal appearances will be presented with comparison to the normal ultrasound appearances. 1130-1300Plenary Session 4: The Renal Patient | Head - Fistula - Kidney - Toes Session Chair: Sue Monaro and Lucy Stopher1250-1300Abstract 72069: Foot care in the renal patient the need for an integrated approach Ereena Torpey | Podiatrist, Adelaide Patients with renal failure are at significant risk of lower limb complications including ulceration, infection and subsequent hospitalisation. Patients with CKD have a similar risk of amputation as those with Diabetes, while Dialysis appears to be an independent risk factor for foot ulceration and/or amputation. The lower extremity amputation rate for those with end stage renal disease and diabetes is 10x higher than diabetes alone. Unfortunately, these patients often have multiple comorbidities, multiple appointments, are complex and resource intensive to manage, increasing their poor outcomes. An integrated approach to care is required for these patients to ensure appropriate education, close monitoring and early referral to appropriate services.1300-1400Lunch 1400-1550Plenary Session 5: Vascular Patient and Interventions Session Chair: Theresa OKeefe and Tanghua Chen1400-1410Abstract 72033: AAA screening Implications for implementation in South Australia Frank Guerriero | Vascular NP Candidate, FMC Adelaide Abdominal aortic aneurysms (AAA's) are a dilation of the aorta below the diaphragm to a diameter of 3cm or greater. With a large majority of AAA's being asymptomatic and high mortality rates associated with rupture (90%) there is a strong argument for the implementation of screening programs to facilitate early identification of this silent and deadly disease. Early identification of AAA's at high risk of rupture (diameter ≥5cm) facilitates planning for repair. Both endovascular intervention and open surgery carry a low rate of peri-operative mortality (0.5-6.0%) in the elective setting. Furthermore, patients with AAAs have a significant burden of co-existing cardiovascular disease and are at high risk of future cardiac, cerebral, and peripheral arterial events. Detection will enable risk factor control and potential disease prevention through education and optimised medical management, such as hypertension control, statin therapy and antiplatelet agents. Whilst there are currently no formal policies, guidelines or programs for AAA screening in Australia, there is a substantial body of published literature supporting successful screening programs in other countries such as the United Kingdom and the United States. This presentation aims to provide an overview and discussion of AAA disease prevalence, identification of at-risk populations, learnings from international screening data and implications for implementation of a pilot screening program in South Australia (currently planned).1400-1550Plenary Session 5: Vascular Patient and Interventions Session Chair: Theresa OKeefe and Tanghua Chen1410-1430Invited Speaker | Management of AAA: The Latest Trends and Outcomes Dr Nadia Wise (Blest) | Vascular Consultant, FMC Adelaide1430-1440Abstract 72061: What We Know (and Dont Know) About Exercise Treatment of PAD Dr. Hong Yau Tan | Vascular Research Fellow, FMC , Adelaide Peripheral arterial disease (PAD) is an occlusive disease of the lower limb arteries with the ability to significantly impact on quality of life and long-term health outcomes. The most frequent manifestation of PAD is intermittent claudication (IC), defined as walking-induced pain and cramping in one or both legs (most often calves) relieved by rest. Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC), which was revised in 2007 recommended that supervised exercise training (SET) should be made available as part of the initial treatment for all patients with peripheral arterial disease. What we know are: SET improves maximal walking time and pain free walking distance (Lane 2014) compared to unsupervised or home exercise (Fokkenrood 2013) and is safe (Gommans 2015). Also, calpain activity increases in correlation to decreased SMM (Delaney 2014) which implies muscle damage and ischemia-reperfusion injury (IRI). However, there are gaps within the knowledge of SET for claudication: long term cardiovascular outcomes and differences in protein expression in diseased muscle compared to healthy individuals. There is also the necessity to explore more about IRI. Previous research on claudicants enrolled into supervised exercise training (SET) by our unit showed functional improvements with patients but physiological deterioration in the form of skeletal muscle damage. The aim of the unit is to investigate the paradox between functional improvement of SET and physiological deterioration via gene expression comparing claudicants and healthy controls. By doing so, we hope to answer the gaps in knowledge and revolutionise the bio-molecular study of PAD. 1400-1550Plenary Session 5: Vascular Patient and Interventions Session Chair: Theresa OKeefe and Tanghua Chen1440-1450Abstract 72345: Non-Surgical Management of Critical Limb Ischaemia Dr Joe Dawson | Vascular SMP, CALHN, Adelaide Introduction Critical limb ischaemia (CLI) carries poor prognosis for both life and limb; 20% of patients undergo amputation and 20% die within a year. Gold standard treatment is revascularisation, but despite advances in endovascular and surgical techniques a large group of patients remain unsuitable due to comorbidities, poor run-off vessels or non-ambulatory status. Options are therefore limited to amputation, palliation or alternative non-surgical therapies. Methods We reviewed non-revascularisation-based treatment for CLI. The number of uncontrolled and heterogeous studies precluded systematic review. Heterogenicity included patient groups, lesions (anatomical and wound), and end points (limb salvage, amputation-free survival, pain relief, ulcer healing). Treatments were divided into (A) Interventional (spinal cord stimulation (SCS), lumbar sympathectomy, intermittent compression) (B) Pharmacological (prostanoids, vasoactive drugs, vasodilators, anti-platelets, anti-coagulants, defibrinating agents, hyperbaric oxygen and (C) Conservative Treatment (wound care). Results Despite the numerous modalities of non-revascularisation treatment for CLI there is no strong evidence to support any of the treatments reviewed. Weak evidence suggests that SCS, sympathectomy, intermittent compression and prostanoids may benefit in terms of pain relief, wound healing or limb salvage. Conclusions Despite the paucity of evidence many techniques are still used for CLI due to the dismal prognosis and lack of options. Genetic and cell-based treatments designed to promote therapeutic angiogenesis are currently under investigation and may provide hope for the future. In the meantime adjuncts to wound healing such as good wound care, nutrition, debridement and eradication of infection still have an important role to play in this most challenging group of patients.1450-1500Abstract 71025: Evolving Technology for Infra-inguinal Peripheral Arterial Disease Dr. Cameron Robertson Vascular RMO, FMC, Adelaide Endovascular technology is changing at a rapid pace. New devices bring the promise of longer patency but long-term data is lacking and the financial costs are significant. Understanding how new technology compares with existing technology will help clinicians make decisions and tailor treatment to specific patients. A systematic review of the literature was conducted to July 2015. Medline, EMBASE, and the Cochrane CENTRAL registry were searched for randomised controlled trials and prospective trials involving drug-coated balloons, drug-eluting stents, bare nitinol stents, and heparin-bonded covered stents in the infrainguinal region. Primary Patency, Target lesion revascularization, and mortality were compared. Each technology is compared and their evidence reviewed.1500-1510Abstract 70501: Role of DCB in the treatment of lower limb stenotic and occlusive PAD Mel Toomey | Vascular Technologist, FMC, Adelaide Peripheral arterial disease (PAD) affects thousands of adults across Australia, typically presenting with symptoms of intermittent claudication, and is associated with significant morbidity, mortality and reduced health status. Apart from risk factor modification and exercise therapy, invasive surgical or endovascular revascularizations remain our only treatment options. Multiple studies have been published on the short and long term success of performing percutaneous angioplasty (PTA) and/or stenting for PAD. Despite this restenosis remains a major limitation to long term patency and clinical usefulness of PTA and stenting. Drug Coated Balloons (DCB) are new and promising treatments to reduce restenosis post PTA, albeit at a higher cost that standard angioplasty balloons. DCB's have been shown to be successful in clinical trials however these studies have typically been conducted in highly selected patient populations not indicative of the general PAD population. In addition the effectiveness and longevity of DCB treatment varies widely depending on the target vessel, drug coating, incipient and angioplasty balloon design. The Australia and New Zealand DCB registry will assess the clinical utility and cost effectiveness of DCB's in an all-comer cohort being treated with PAD. The study will assess outcomes of clinical improvement, vessel patency and rate of reinterventions out to 2 yrs. post procedure with economic analysis being undertaken to assess cost-effectiveness of DCB vs the less expensive standard angioplasty balloon. 1400-1550Plenary Session 5: Vascular Patient and Interventions Session Chair: Theresa OKeefe and Tanghua Chen1510-1520Invited Speaker | Catheter Directed Thrombolysis (CDT) - 10 Years Experience at a Major Tertiary Referral Hospital Vivien Moult | Vascular Trainee, CALHN, Adelaide Purpose: Over the past decade catheter directed thrombolysis (CDT) has gained increasing popularity in the management of arterial and venous thrombosis. The aim of this study is to ascertain the safety and efficacy of CDT relevant to the Australian population. Methodology: In total, 124 consecutive patients that underwent CDT between 2002 and 2011 were identified and reviewed. In all patients; demographics details, co-morbidities, aetiology, thrombolytic regimes and techniques, length of thrombolysis, complications, and 30-day mortality was assessed and analysed. Results: Average age was 65.2 (15-95) years with a male to female ratio of 69:55. 75% of cases were arterial and 2424.2% venous thrombosis, with one (0.8%) AV fistula thrombosis. CDT was performed by interventional radiologists in 76.2% of patients, vascular surgeon in 15.3% and both (radiologist and vascular surgeon) in 12.1% of patients. Urokinase was used in all patients with an initial bolus dose administered to 58.9% of patients and an average infusion rate 76,454units/hr. CDT was deemed successful in 62.1% of patients, incomplete in 12.9%, and failed in 25% of patients. Overall complication rates were low with retroperitoneal haematoma occurring in 1.6% of patients, and pseudo-aneurysm in 7.3% of patients. The 30-day mortality was 6.5%. Conclusions: Our series confirms the safety and efficacy of catheter directed thrombolysis for both arterial and venous thrombosis. These results are an important contribution to the current evidence base, particularly in the treatment of venous thrombosis. The wide range of CDT techniques and dosage regimes used highlights the need for further research and standardisation into best practice thrombolytic protocols.1520-1530Abstract 68945: A review of major Amputations over a one year period in a major vascular surgical unit Sue Monaro | Vascular Nurse, Sydney Background: Major amputation is a significant part of case-mix in vascular surgical units despite improvements in technology for revascularisation. Patients tend to be elderly and complex, making length of stay targets difficult to achieve. Aim: This series reviewed separations coded for major amputation in a one year period at a major metropolitan teaching hospital to provide some scope of the complexities of patients. Method: Medical records coded for major amputation were reviewed capturing multiple variables relating to the patients pre-operative functional and physical state, previous vascular interventions and post-operative complications, discharge destination and length of stay. Findings: 26 patients had undergone a total of 30 major amputations which included four conversions from below to above knee. Many had undergone multiple procedures prior to amputation and there was a high rate of complications post-operatively. Conclusion: Major amputation for dysvascular disease continues to present challenges to the vascular team because of the patients frailty and the high rate of complications. Consideration needs to be given to assist the team to work with the patient and family to make timely and appropriate decisions. The difficulty optimising the condition of these patients and delays in proceeding to surgery may be incorporated into an advanced care plan.1530-1545ANZSVN Conference Awards, Scholarship Award and Closing Address     VASCULAR 2015 | PROGRAMME  $%/@AEFJKeɹ}kYkI8 hQu5:CJOJQJ^JaJhTp>h65OJQJ^JaJ#hTp>h05CJOJQJ^JaJ#hTp>h65CJOJQJ^JaJ&hTp>h-l56CJOJQJ^JaJ&hTp>h-l5:CJOJQJ^JaJ&hTp>h05:CJOJQJ^JaJhTp>h-l5OJQJ^JaJ#hTp>h-l5CJOJQJ^JaJ#hTp>h5CJOJQJ^JaJ#hTp>hlB5CJOJQJ^JaJ %@AKHkd$$Ifl,0)S% 0(4 lapytpF $Ifgd'$$If]`a$gd0PgduenpȹڥueuSC/&hTp>h5:CJOJQJ^JaJhTp>h65OJQJ^JaJ#hTp>h65CJOJQJ^JaJhTp>hb5OJQJ^JaJ#hTp>h5CJOJQJ^JaJh456CJ OJQJaJh656CJ OJQJaJ&hTp>h656CJOJQJ^JaJhy:CJOJQJ^JaJ#hyh6:CJOJQJ^JaJ#hyhy:CJOJQJ^JaJ&hTp>h65:CJOJQJ^JaJniiUH xx$IfgdkY$$If]`a$gdbgd6kd$$Ifly0)S% ԴԴ0(4 lapԴԴytpFniiUH xx$IfgdkY$$If]`a$gdbgd6kd$$Ifl0)S% 0(4 lapytpF' ( ) 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