Diagnostic-disease targeting, such as abdominal aortic aneurysmal disease.

This is likely to lead to potential therapeutic genetic interventions

Gene editing techniques are currently being used for xenogenic organ growth in pigs for planned eventual use in humans. Such techniques might be applicable for vessel growth

Robotic surgery has the potential to offer less invasive procedures with shorter length of hospital stay. The caveat to this approach is the current high costs associated with robotic surgery, and the relative ease of endovascular approaches.

3D Printing

These techniques have the potential to assist in specific endo graft development. The combination of 3D printing and regenerative medicine may allow patient specific ‘biologic’ grafts to be developed.

Endothelial seeding

Endothelial seeding onto a 3D matrix might improve graft patency and reduce infection risk

Stem cells

Stem cell vascular regeneration including the restoration of normal vascular function and structure; the reversal of vascular senescence; and the growth of new blood vessels is already in progress and likely to become more important in the future

Artificial intelligence.

Reducing radiation dosing, better computer modelling.

Synergistic or integration of multimodal imaging such as 3D ultrasound

Point of care U/S

Fusion imaging

Software engineering to generate 3 D models of diseased circulation and plan interventions and predict outcomes

Thrombo elastograms (TEG) represents a recent development in point of care tests for bleeding. It is likely that further tests will be developed for use either in the community or in hospital such as the ‘SmartChip’ for ischaemic and glial fibrillary acidic protein (GFAP) for traumatic brain injury

Sepsis is a cause of death of people with vascular disease, from infected lower limb wounds or implanted devices.

Surgical site infection is a cause of significant morbidity and mortality.

Novel antibiotics, implant covering or implant technology such as biologically compatible or absorbable materials need to be developed

Greater interrogation of the existing data sets in the community or using the NVD are like to inform decision planning Easier methods of data capture including standardised approach to patient information recoding electronically across NHS. Voice activated recoding to avoid repetitive writing, prompts for questions. Integrated investigation and therapy pathways allowing clinicians more time to focus on high end decision making.

• Intelligent audit and unique device identifier NVR (Outcome Registries Platform)
• Single uniform computerised NHS patient database
• Integration across providers

Technology continues to develop rapidly and the stent options increase rapidly. Better design, novel materials and delivery systems need to match the individual patient characteristics. Recent innovations have been in clot retrieval (i.e. Penumbra) and Fusion Imaging (i.e. Cydar Medcial).

Endovascular atherectomy devices show theoretical promise but the exact technique and their role have yet to be fully defined.

Point of care testing

Thrombo elastograms (TEG) represents a recent development in point of care tests for bleeding. It is likely that further tests will be developed for use either in the community or in hospital such as the ‘SmartChip’ for ischaemic and glial fibrillary acidic protein (GFAP) for traumatic brain injury

There is likely to be a development of virtual care and clinics improving of patients access to expert opinion.

Remote monitoring of leg ulcers and problem wound care will be supervised in a remote fashion.

Wearables and their role in disease prevention is being explored in research.

Remote monitoring of patients eg diabetic foot using nanotechnology. Pressure and temperature sensors embedded in footwear and sending data ro remote monitoring centre via mobile phone. Subject only contacted if abnormal results

There is an emerging role for AI in the interpretation of images and this may well be applicable to say endograft selection or even management of complex patients.

Merging genomics and other –omics (proteomics, metabolomics) with an individual’s cardiovascular risk factors and individual circumstances should inform clinicians about diagnosis, planning of treatment efficacy of treatment and prognosis.

Novel vascular drugs are more likely either to come from cardiological and / or diabetic routes if one considers the patient numbers and relative cost margins.

Re-targeting of existing drugs in novel settings such as metformin for delaying AAA growth is a relatively inexpensive approach to existing conditions.

Combination use of drugs (such as aspirin and clopidogrel) has been used to great beneficial effect. There is emerging evidence of the use of synergistic existing drugs combinations in personalized approach to cancer treatment. It is likely that options may be suitable for vascular patients.

Simulation 

Endovascular training- virtual reality and simulated reality systems

Surgical training-individual and team based training within simulated environments

Cadaveric training is both popular and helpful for specific situations

Immersion training

Mentor via video Such as Proxime (mentor)

• “Touch Training” before real life surgery
• Modelling and planning interventions

The introduction of the WHO Checklist is an example of a simple approach which reduces basic and avoidable surgical events. This approach could be further refined and developed perhaps along the lines of inter-operative checks during multidisciplinary trauma surgery

Priority setting

The VS has undertaken the first Delphi process to determine the research priority setting for vascular surgery. 

This has led to NIHR funding a greater number of vascular research studies.

Vascular research collaborative (VERN)

The Vascular Research Collaborative is beginning to gain traction with trainees both leading and participating in trials. This has been shown to be a key approach to engaging trainees with research and is likely to be important in long term support for research and innovation.

Patient and public involvement

We need to develop an expectation for patients to want to be enrolled in research and to facilitate their involvement in the design of future proposals

Patient reported outcome measures (PROMS)

A focus and work is needed in this area. Patient reported outcome measures registry could potentially inform future areas for improvement in care

Registry based research

NVR data is starting to be used to collect data for research studies. This avoids duplication of effort and will improve data quality.

Failure to recognise the reality of ongoing funding restrictions would risk offering naïve aspirations that would ultimately fail to gain traction from key funding bodies. The need to demonstrate value for money, improved QoL, longevity of intervention and efficacy in delivery are key components when considering the future of vascular surgery.