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The History of “TransAtlantic Vascular Medicine”
All health fields that create new knowledge ideally do so in an environment in
which challenges are identified, promising diagnostic and therapeutic
interventions are carefully evaluated, and insights are rapidly disseminated to
health professionals, government agencies, business, and the public.
Vascular diseases are among the most prevalent causes of international
cardiovascular morbidity and mortality. Individual national vascular
subspecialty scientific sessions provide one helpful forum to foster such
discussion. However, for the past 15 years, it has been recognized that there is
value when international experts gather in smaller venues to confront the most
critical issues of PAD investigation and care.
This type of expert interchange
has been fostered within the “TransAtlantic Vascular Medicine Meetings” that
have been held since 1994. This unique international collaboration has
successfully leveraged the leadership of many prominent individuals to create
landmark positive impacts on PAD public health (figure 1: The TransAtlantic
Collaborative Timeline).
These meetings have created the vision and perspective that have shaped current
PAD drug and device development and that has guided regulatory agency reviews.
We welcome you to join in sustaining this tradition as we guide our field toward
the next decade of vascular care advances!
A synopsis of the past meetings follows:
EUROCHAP-94, May 1994, Lund, Sweden
The first template for this PAD-focused meeting format was organized by the
Swedish Societies of Medical Angiology and Vascular Surgery together with the
Forum of Angiology of the Royal Society of Medicine, UK, a collaboration that
demonstrated the value of sustaining an expert colloquium aimed at discussing
the comprehensive components of vascular patient care, extending from early
investigation to bedside care. This aim was well-fulfilled by well known
international speakers who engaged in productive discussions.
The Pharmacotherapy of Claudication:
A New Frontier for Vascular Therapies, May
1995, Washington, DC, USA
This first Trans-Atlantic meeting was hosted by the Society for Vascular
Medicine and Biology (USA) and began the new TransAtlantic discussions designed
to advance the frontiers of vascular practice. Participation initially included
an informal international consortium of clinicians and scientists whose
professional work related to therapeutic strategies for PAD.
The focus of the
first conference was on establishing visibility for a new frontier of vascular
pharmacotherapeutics for peripheral arterial disease focused on the dual goals
of diminishing disability and death, and to improve limb function and survival.
Prior to 1995, these goals were not clearly established!
The First Trans-Atlantic Vascular Medicine Symposium — Trans-Atlantic Vascular
Medicine: Controversies and Consensus, May 1997, Boston, MA, USA
The success of the first meeting led to the formal creation of a new
TransAtlantic concept: “TransAtlantic Vascular Medicine” in order to assure that
an ongoing forum would exist for such PAD discussions. The effort was formally
sponsored by the Society for Vascular Medicine Biology, the Angiology Forum of
the Royal Society of Medicine, and the Swedish Societies of Medical Angiology
and Vascular Surgery, with occasional participation of other members of the
international Union of Angiology.
At this meeting, panel discussions were held
on the following topics: advances in vascular biology as the foundation of
future therapies; atherosclerosis risk factors and medical therapies:
intervention to improve survival of both life and limb; the international
regulatory environment for vascular disease therapies; outcome measures in
vascular disease; the role of thrombolysis in vascular disease; and a
”point–counterpoint” interchange on clinical approaches to chronic PAD care:
from controversy to consensus. This meeting clarified the importance of the dual
EU and USA regulatory environments and need for increased clarity on
establishing PAD clinical trial outcome measurements.
Transatlantic Conference on Clinical Trial Guidelines in Peripheral Arterial
Disease:
Clinical Trial Methodology. Basel PAD Clinical Trial Methodology Group,
November 1997, Basel, Switzerland.
Guidelines for the clinical development of drugs in peripheral arterial disease
(PAD) have been issued by the Food and Drug Administration (FDA) for the United
States and by the European Medicines Agency (EMEA). With increasing
globalization, transatlantic cooperation in drug research and development was
considered an essential feature that could facilitate both the creation of new
therapies and care guidelines.
The conference was convened to discuss the
scientific background of the existing guidelines on the basis of published
evidence and the extensive knowledge of clinical investigators and experienced
regulators. The meeting was attended by 52 invited experts from the United
States and Europe, as well as by representatives from the 2 regulatory
authorities. The main conclusions from the meeting were published as a reference
for development of transatlantic guidelines for the evaluation of
pharmacotherapy in PAD (Labs KH, et al. Circulation. 1999 Oct 26;100(17):e75-81
The Second Trans-Atlantic Vascular Symposium, September 1999, Edinburgh,
Scotland, UK.
This meeting was also co-hosted by the Society for Vascular Medicine and
Biology, the Angiology Forum of the Royal Society of Medicine, and the Swedish
Societies of Angiology and Vascular Surgery as a tri-partite exploration of
vascular biology, clinical care and reviewed the future prospects for the
training of the next generation of vascular internists/angiologists. This meeting created a consensus that there was a pressing need for creating a focus
on establishing training program to create the next generation of vascular
clinician-investigators. Since this meeting, such training programs have indeed
been established.
The Third Trans-Atlantic Vascular Medicine Symposium:
Pharmacotherapy of
Peripheral Arterial Disease An Expanding Frontier for Vascular Therapies, April
2002, New York, New York, USA
Co-hosted by the Society for Vascular Medicine and Biology, the Angiology Forum
of the Royal Society of Medicine, the Swedish Societies of Medical Angiology and
Vascular Surgery and the International Union of Angiology, the third
Trans-Atlantic Vascular Medicine meeting and Second Pharmacotherapy of PAD
Scientific Symposium provided state of the art reviews and “late breaking”
clinical trial data discussed by international experts in vascular diseases.
This meeting clarified that there was, and remains, no single forum in which
major PAD clinical trials are presented. The lack of profile of PAD trials at
most major cardiology and vascular annual scientific meetings was identified, of
itself, to serve as a barrier to drug and device development, as well as
translation of current knowledge to practice.
16th European Chapter Congress of the International Union of Angiology
(EUROCHAP), October 2005, Glasgow, Scotland, UK
Co-hosted by the Angiology Forum of the Royal Society of Medicine, the Swedish
Societies of Medical Angiology and Vascular Surgery, Society for Vascular
Medicine and Biology, and the International Union of Angiology, the Fourth
Trans-Atlantic Vascular Medicine. This meeting included sessions on: novel
insights from basic science to clinical investigation; insights from
epidemiological studies of vascular disease; translational vascular medicine and
biology; insights from clinical trials focusing on ‘why is the SFA different?’;
and assessment of QOL outcomes in CLI.
Join us in Örebro, Sweden, on May 12-13, 2009,
as a prominent, productive, and collaborative international vascular health
tradition is continued…
TransAtlantic Vascular Medicine Extends Its Impact-
From Collaboration to the Creation of International PAD Care Standards
The Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral
Arterial Disease (TASC) was published in January 2000 (1-3) as a result of
cooperation between fourteen medical and surgical vascular, cardiovascular,
vascular radiology and cardiology societies in Europe and North America. This
comprehensive document had a major impact on vascular care amongst specialists.
In subsequent years, the field has progressed with the publication of the
CoCaLis (4) document and the American College of Cardiology/American Heart
Association Guidelines for the Management of Peripheral Arterial Disease (5).
Aiming to continue to reach a readership of vascular specialists, but also
physicians in primary health care who see patients with peripheral arterial
disease (PAD), another consensus process was initiated during 2004. This new
consensus document (TASC-II) has been developed with a broader international
representation,
including Europe, North America, Asia, Africa and Australia, and with a much
larger distribution and dissemination of the information (6).
When health care professionals sustain their dedication to the public health by
merging their individual strengths with collaborative bonds, monumental outcomes
can be achieved.
References:
1. TASC. Management of peripheral arterial disease (PAD). TransAtlantic
Inter-Society Consensus (TASC). Eur J Vasc Endovasc Surg 2000; 19(Suppl
A):Si-xxviii. S1-250.
2. TASC. Management of Peripheral Arterial Disease (PAD) TransAtlantic
Intersociety Consensus (TASC). J Vasc Surg 2000;31(1 part 2):S1-287.
3. TASC. Management of peripheral arterial disease (PAD). TransAtlantic
Inter-Society Consensus (TASC). Int Angiol 2000;19(1 Suppl.1):I-XXIV. 1-304.
4. Clement DL, Boccalon H, Dormandy J, Durand-Zaleski I, Fowkes G, Brown T. A
clinical approach to the management of the patient with coronary (Co) and/or
carotid (Ca) artery disease who presents with leg ischaemia (Lis). Int Angiol
2000;19(2):97-125.
5. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL et al.
ACC/AHA 2005 guidelines for the management of patients with peripheral arterial
disease (lower extremity, renal, mesenteric, and abdominal aortic): executive
summary a collaborative report from the American Association for Vascular
Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and
Interventions, Society for Vascular Medicine and Biology, Society of
Interventional Radilogy, and the ACC/AHA Task Force on Practice Guidelines
(Writing Committee to Develop Guidelines for the Management of Patients With
Peripheral Arterial Disease) endorsed by the American Association of
Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood
Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus;
and Vascular Disease Foundation. J Am Coll Cardiol 2006;47:1239-312.
6. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, and Fowkes FGR on
behalf of
the TASC II Working Group, Inter-Society Consensus for the Management of
Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45:S5A-S67A
Figure 1: The TransAtlantic Collaborative Timeline
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