Ross Milner教授：主动脉弓腔内技术的全球进展及AI在血管外科中的应用前景 | ASVS 2024

我是Ross Milner，是芝加哥大学医学中心的一名外科教授兼血管外科主任。我在这所大学已经工作了将近 13 年，我非常感激能有这个机会与大家见面交流。我组建了一支团队，团队成员们对血管外科的各个方面都有着广泛的兴趣。我们团队在治疗多种血管疾病方面非常精通，擅长处理动脉瘤疾病、颈动脉疾病、静脉疾病，也负责透析通路相关问题。总体而言，我们全面涵盖了整个血管外科领域的各类情况。我们的工作在芝加哥大学医学中心的血管外科领域发挥着重要作用，因为我们旨在为患有不同血管问题的患者提供有效的治疗。

I am Ross Milner, a professor of surgery and the chief of vascular surgery at the University of Chicago Medicine. I have been here for nearly 13 years and I really appreciate this opportunity to meet all of you. I have established a team whose members possess broad interests across all aspects of vascular surgery. We are highly proficient in treating various vascular diseases. We deal with a large number of aneurysm cases, carotid diseases, venous problems, and also take care of dialysis access. Generally speaking, we comprehensively cover the entire scope of vascular surgery. Our work holds great significance in the vascular surgery field at the University of Chicago Medicine, as our aim is to provide effective treatment for patients with diverse vascular issues.

芝加哥在血管外科领域呈现出一种独特的景象。这里有许多像我所在的大学医学中心，还有繁忙的社区医疗项目。整个芝加哥地区的人口约达 800 万，从美国的情况来看，这是一个相当庞大的数字。与我近期去过的中国北京和上海等城市相比，其规模也不容小觑。

Chicago presents an interesting scenario for vascular surgery. There are several university medicine similar to the one where mine is affiliated, along with bustling community programs. The Chicago land area has a population of approximately 8 million, which is relatively large in the context of the US. In comparison to cities in China like Beijing and Shanghai I have visited recently, it is still sizable. 

在这个地区，并没有一个绝对占主导地位的医疗项目，而是有多个较为繁忙的中心，我所在的地方就是其中之一。这意味着鉴于我们所服务的大量人口，我们要负责照料众多的患者。总的来说，芝加哥的血管外科领域丰富多样且充满活力，众多机构和项目相互协作与竞争，为当地居民提供医疗服务，这样的环境很可能促进了该地区血管外科实践的持续发展与创新。

There isn't a single overwhelmingly dominant program in the region; instead, there are various busy centers, with my institution being one of them. This means we are responsible for a significant number of patients, given the large population we serve. Overall, the vascular surgery field in Chicago is diverse and active, with multiple institutions and programs collaborating and competing to provide care to the local population, and this environment likely contributes to the continuous development and innovation in the practice of vascular surgery within the area.

对于许多有一定经验的从业者来说，人工智能在医疗领域尤其是血管外科的出现，最初因其影响不明而令人心生畏惧。然而，我在过去的 18 个月里收获了深刻的认识。我与诸如 Cydar 这样的公司合作，该公司利用基于云成像系统进行术中引导、术前规划以及术后随访，这使我对人工智能在成像方面的潜力有了更深入的理解。另一家公司 Nurea，其自动化成像和分割技术也参与到了他的研究中。我在 ASVS 上的报告聚焦于利用计算机建模来处理主动脉夹层问题，以实现个性化医疗，包括确定合适的修复时机和类型。

For many experienced practitioners, the emergence of AI in the medical field, especially in vascular surgery, was initially intimidating due to a lack of understanding of its implications. However, I have gained significant insights over the past 18 months. I have worked with companies like Cydar, which uses a cloud-based imaging system for intraoperative guidance, preoperative planning, and postoperative follow-up, enhancing my understanding of AI and its potential in imaging. Another company, Nurea, with its automated imaging and segmentation technology, has also been involved in his research. My presentation at ASVS focused on using computer modeling for aortic dissection to personalize care, including determining the right timing and type of repair. 

通过与这些公司合作，我和我的团队正在探索如何针对不同的解剖结构选择最合适的医疗器械。总体而言，最初对人工智能的恐惧已被对其益处的认识所取代。人工智能预计不仅会在我们的本地实践中发挥关键作用，在全球范围内亦是如此，它将帮助外科医生在患者护理和器械选择方面做出更好的决策，最终提升血管外科领域的治疗质量和患者的治疗效果。

By collaborating with these companies, me and my team are exploring how to select the most suitable devices for different anatomies. Overall, the initial fear of AI is being replaced by an understanding of its benefits. AI is expected to play a crucial role not only in our local practice but also globally, helping surgeons make better decisions about patient care and device selection, ultimately improving the quality of treatment and patient outcomes in the field of vascular surgery.

Nurea官网：nurea-soft.com

从血管腔内治疗主动脉弓的角度来看，美国以外地区的相关经验目前要比美国本土丰富得多。在美国，目前有一款获批的器械，即戈尔（GORE）公司的胸部分支器械，不过目前其获批范围仅针对带有分支的左锁骨下动脉，但有望在明年获得针对整个主动脉弓的批准。我是 ENDOSPAN 公司一款名为 “NEXUS” 器械的共同国家主要研究者，该器械已获得 CE 认证并已在欧洲及世界其他地区投入使用，为以微创方式治疗主动脉弓病变提供了机会。

In the treatment of aortic arch from an endovascular perspective, the experience outside the US is currently much more extensive than that in the US. Currently, in the US, there is one approved device, which is the thoracic branch device by GORE. Its current approval is only for the left subclavian artery with the branch, but it's expected to get approval for the entire aortic arch within the next year. I involved as a co-National Pi for a device called the NEXUS device from ENDOSPAN. This device already has a CE market and is being used in Europe and other parts of the world, providing an opportunity to treat aortic arch lesions in a less invasive way.

Endopan官网：endospan.com

总体而言，美国在这方面相较于世界其他地区稍显落后，但目前正在取得进展。随着戈尔器械的存在以及其他新技术有望出现，该领域的许多人认为，从血管腔内角度对主动脉弓进行治疗一直是个薄弱环节，但现在正开始追赶世界其他地区。这意味着美国在主动脉弓血管腔内治疗方面的能力正在逐步增强。

Overall, the US is somewhat behind other parts of the world in this regard, yet progress is being made. With the existing GORE device and the anticipation of other emerging technologies, many in the field see the treatment of the aortic arch from an endovascular aspect as an area that has been lacking but is now starting to catch up with the rest of the world. It indicates that the US is gradually strengthening its capabilities in endovascular treatment for aortic arch problems.

我觉得自己特别幸运，因为我有过很多外出旅行的机会，至今已经去过 37 个国家了。在去年 9 月，我第一次获得了前往中国的机会。当时我作为医师之一，跟随Silk Road Medical团队前往中国，助力在中国启动经颈动脉血管重建术（TCAR）。那是一段无比美妙的经历，我遇到的人们、去过的医院以及结识的医疗团队，都对我们的加入感到十分兴奋。我还得以协助完成了在上海进行的首例经颈动脉血管重建术。总之，那次在中国的行程让我度过了一段特别美好的时光。

I feel truly fortunate as I've had numerous opportunities to travel around the world, and I've already been to 37 countries. In September of last year, I got the chance to visit China for the first time. I went there as one of the physicians with the team from Silk Road Medical to assist in launching TCAR in China. It was an absolutely fantastic experience. The people I met, the hospitals I visited, and the medical teams there were all excited to have us. I was even able to help with the first TCAR procedure carried out in Shanghai. Overall, I had an amazing time during that trip in China.

复旦大学附属中山医院临床引入TCAR技术，开启颈动脉狭窄治疗新篇章

过去，我只是线上参加过一些会议，一直没机会亲自到现场。不过，我非常期待能再回去，因为我已经收到了好几份邀请，希望我在接下来的一年里重返中国。我热切盼望着再次到访，再次感受初次访问时给我留下的深刻印象和专业氛围。

In the past, I only participated in some meetings virtually and didn't have the chance to be there in person. However, I'm really looking forward to going back as I've received several invitations to return to China in the upcoming year. I'm eagerly anticipating revisiting and experiencing again the warm welcome and professional atmosphere that left a deep impression on me during my first visit.

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