Elevating Limb Preservation: A Look Inside the AMP Symposium With Drs Bret Wiechmann and Richard Neville

Join new course directors Dr. Brett Wiechmann and Dr. Richard Neville as they offer a preview of the 2025 Amputation Prevention Symposium (AMP), the leading conference dedicated to education and innovation in limb preservation and CLTI care. Discover what’s new this year and how this multidisciplinary meeting empowers learning, networking, and patient-centered breakthroughs. This episode is also available on Spotify and Apple Podcasts.

Welcome to Vascular Voices, the podcast of Vascular Disease Management, the peer-reviewed online journal that educates readers on the latest advancements and endovascular treatment strategies. In this episode, Interventional Radiologist Dr Bret Wiechmann and Vascular Surgeon Dr Richard Neville discussed the upcoming Amputation Prevention Symposium taking place August 13th to 16th in Chicago. Dr Wickman and Dr Neville are the lead course directors for the symposium, and they talk about why AMP is the premier meeting for CLTI education and amputation prevention, what's new at this year's meeting, and why you should attend.

Dr Wiechmann: My name is Bret Wiechmann. I'm an interventional radiologist in Gainesville, Florida, and I've been in private practice for almost 28 years as of this summer. And I've always had a strong interest in peripheral arterial disease and specifically critical limb ischemia and been part of a number of clinical trials dating back many years. And I've been very fortunate to be a lead course director with you, Rich. And with that, I'll let you introduce yourself and tell us a little bit about your practice. 

Dr Neville: Oh, thanks, Bret. Yeah, so I'm Rich Neville. I'm a vascular surgeon by training and always been passionate about limb preservation and amputation prevention. I spent about 20 years at Georgetown University where we started the program there with Chris Attinger, who still is in practice, actually. It started our wound center at Georgetown, then spent a couple of years at GW, and now I'm in the ANOVA system out in Northern Virginia, where we're actually trying to get our program moving and get our program matured to prevent amputation and limb preservation.

So a meeting like AMP is critical to the initiatives we're trying to do here at ANOVA. I always learn so much at the meeting and am looking forward to this year's meeting.

Dr Wiechmann: I am too, Rich as well, you know, and I think that with you and I being the lead course directors now as of this year, I think we've talked about this before about expectations for attendees at the meeting, and we both have been part of the meeting in the past as faculty, and I think that there's been a tremendous precedent for this meeting. Clearly, it's at least, to my knowledge, the only national and international meeting focused on limb preservation and critical limb ischemia or chronic limb-threatening ischemia. That topic has been a part of numerous other vascular meetings, as we both know. But this is really focused on the CLTI space. So tons of topics of interest, new techniques, new devices, all that stuff is part of AMP. What else do you think people can look forward to by attending? 

Dr Neville: Those are great points, Bret, and I just want to reiterate that this meeting is really dedicated to all that is required to save limbs from the vascular component, and we're going to really try to enhance the soft tissue component and the other things that go along with just the revascularization. But to your point, Bret, you know, I go to all our other national meetings and there's multiple topics discussed and, you know, and so this is really a focused meeting on just limb preservation and amputation prevention. And I think what Bret and I are going to try to do, we've talked about this at length, what we'd like to do is build on the outstanding foundation that's already been, you know, developed by the founders. I mean, this was a great meeting from the start, but I think there's some room to grow it, to expand it, to expand the reach, to add new components of the meeting, building upon those things that were successful in the past. So, yeah, I hope we just continue to push it forward. And I really think people will find that the meeting is enjoyable, But also, I always, you know, learn a lot. And then you also get to meet other people engaged in the field. Don't you think, Bret? That’s another key. 

Dr Wiechmann: That's absolutely a good point. You know, we learn so much from the agenda content, and I think that it's an incredible educational experience, but we learn so much from the hallway conversations that we all have with each other, plenty of industry support to look at the latest and greatest tools. So I do think the networking part of this is critical, and again, sometimes those hallway conversations are more meaningful. You get to gather with colleagues that you haven't seen for a few months or many months.
So no doubt that that is critical and you know to your point too, Rich, about the soft tissue component the wound care, all that stuff is critically important to limb salvage and patients in dealing with a threatened limb. We all love new gadgets. We all love to hear new techniques We like to hear, you know, fancy surgical procedures. But there's so much more to it in terms of getting a wound to heal and a limb to be saved. It's way beyond just the intervention, isn't it? 

Dr Neville: Yeah. Isn't that the truth, Bret? I think one of the real strengths of the meeting is it's multidisciplinary. It's always been very multidisciplinary, but some of the other vascular meetings we go to, it's all vascular surgeons or it's all IR, it's all cardiology. This, you really get a nice interaction and a mix. I always get some new ideas and learn some things from other folks that are involved in this field. And the other thing, Bret, don't you think, I think this meeting, unlike many I go to, the faculty are so approachable. I mean, you know, sometimes you go to some of these national meetings and you're afraid to go up and talk to the person—not afraid but you know it's a little bit intimidating sometimes. I  think the faculty, it's really a very interactive meeting and I think people will find that it's really a lot of fun in that regard, too. 

Dr Wiechmann: I agree. I mean, part of what we have to do is make sure that we're selecting the right faculty. We want to have the conversational piece of this that is very important for the attendees. And I do agree, I think that the faculty by and large has been very approachable. And again, it goes back to those hallway conversations that after somebody is in their talk, right, you want to spend another 10 or 15 minutes—hey, I've got a case where this happened.

Dr Neville: Right.

Dr Wiechmann: You know, what would you do in this scenario? We all get asked those questions all the time. So, I think that's very helpful. The other thing, as we were talking, I was thinking about when we have the late-breaking abstracts or the new research that's been presented, as I look at some of the stuff that we evaluated earlier to try and include in the content, really eye-opening and interesting ideas. Again, not just on the device side, not just on technique side, but you know, medical therapy, new aspects of wound care. And that kind of speaks to the heterogeneity that's out there in this field. We don't know exactly the best way or if there is one best way to take care of these patients in terms of putting everything together from diagnosis to preprocedural management to the actual procedure to things like nutritional aspects afterwards in the wound care and optimizing medical therapy. I saw something recently that I think is going to be talked about at this year's meeting, actually, that we are still extremely poor at managing all the medical things afterwards. It's about one-third of patients are optimized according to the guidelines. And so I'm interested in hearing more about that as well this year.

Dr Neville: Yeah, we started looking at that in our own system just to take a snapshot of the patients that we see in the clinic and you're exactly right, Bret. There's so much to be done. I mean, and that's borne out by the best in the BASIL trials where we're sitting there arguing about which is best, endo vs bypass and when, but they both had mortality rates that were way too high in follow-up. So, I think that's one of the real messages also of the meeting that we've got to really optimize the total care of these folks. 

Dr Wiechmann: So, it just kind of struck me as you were talking about that, the humility that we all have to have, even as people that have given talks at these international meetings for a long period of time now, you really have to come in with a certain amount of humility to be able to learn, and one of the things that I think is remarkable about AMP and how it's been in my long experience, it just kind of made me think of one of the taglines that we had a couple of years ago, which is leave your specialty at the door. 

Dr Neville: Okay, yeah.

Dr Wiechmann: I think that that is critically important because I learn from surgeons and I learn from cardiologists, I learn from podiatrists, I learn from wound care specialists. And sometimes I learn from fellows who are really active in new groundbreaking research. So even though you may be on the podium or you're on a panel, or you're moderating a live case, you catch something that you can learn and apply back in your own practice. So that humility, I think is important. 

Dr Neville: Yeah, absolutely. I'm humbled every case I do; one was trying to humble me the whole day. 

Dr Wiechmann: Yeah, I just got humbled this morning, too.

Dr Neville: Bret, you make another great point. You mentioned the fellows. And I think both of us really want to expand the exposure to trainees. I mean, fellows, people that are thinking about going into the treatment of vascular disease, thinking of people that are, we really want people to bring their trainees, their fellows. We really want to make that a major component of the meeting going forward, whether that's an abstract competition or, we want the young trainees involved, because they're really going to push this forward and we really have to get them more involved going forward,  too.

Dr Wiechmann: I agree, there's room for every level of training, whether it's residents, fellows, early career.

Dr Neville: Right, that's a great point.

Dr Wiechmann: You know, people that finish their training and they go into a practice where perhaps they're asked to do one part of vascular disease. Maybe they're focusing on venous disease or aneurysms, or aortic reconstruction. All of a sudden, they find themselves in a different practice, or maybe somebody within the group retires. So those early careers sometimes shift. So I think that there's room for people with various degrees of experience or inexperience to learn a lot from the meeting. 

Dr Neville: Yeah.

Dr Wiechmann: I think this kind of goes back to the opportunities that we provide at AMP, and with you and I, and we've worked together for numerous years at various meetings. And again, with all due respect to everybody that was involved with this meeting from the very beginning, sometimes it is helpful to have a fresh set of eyes look at the content and mixing up the faculty, maybe consider a different environment for the meeting, and I think that that's going to be good going forward and I know we've talked about different aspects of the vascular community, if you will, that we need to include as part of that discussion. 

Dr Neville: Yeah, those are great points, Bret. I'm excited about it, I really am, to work with you to build on this foundation as we said, so I think it's really exciting. I think this year's meeting is going to be kind of the kickoff toward that initiative. 

Dr Wiechmann: Right. You know, last year, and maybe in years past, I'm trying to recall, we had an unbelievable presentation by a patient. 

Dr Neville: That's right. 

Dr Wiechmann: I think you actually moderated that session. 

Dr Neville: Yeah, that's right.

Dr Wiechmann: We had a patient testimonial who had had chronic limb-threatening ischemia and underwent a DVA. I think that was a very powerful and meaningful testimony and I think everybody was kind of sitting on the edge of their seat. This is really, this is from the voice of a patient that has had to deal with this idea of, I may or may not be able to keep my limb, and through the efforts of physicians and support teams behind it he was able to do quite well. I can't remember exactly how many years out he is from that intervention, but he's got both his legs, and he's functional. So I think the patient testimonial is a big impact. Hopefully we have some more of that this year.

Dr Neville: Yeah, that's a great point, Bret. That was an amazing session. I think sometimes we forget that we’re just focused on opening an artery or healing a wound, you really forget the overall impact you have on these people's outlook and their lives, so I think that's something to be proud of. Yeah, that was an amazing session and I think we should certainly include that moving forward. 

Dr Wiechmann: Right, I agree. Well we talked a little bit before about the faculty, too. That there's various levels of experience within the faculty, you know, every geography in the U.S. has a little bit of a different take, and I'll give you a good example. In my town of Gainesville, Florida, what we do at our facility can look completely different than 15 minutes across town, and certainly within our catchment area, our kind of referral catchment area.

I used the word heterogeneity before because it may look totally different than in Virginia, Seattle, LA, or New York. And I think we've done a pretty good job at bringing in faculty that are from all walks of life, so to speak, not just from a specialty standpoint, but from geography. What works in one place may not work in another place. we found that to be true.

Dr Neville: Yeah, that's exactly right, it's fascinating. It's fascinating you bring that up because we tried to, just in our own contained health system, tried to standardize some of the vascular care. And of course, I was all excited about it and read all the guidelines of all the societies, and we came up with some tenet, but you had to back off. It's really fascinating. Yeah, it's really kind of fascinating, but that's a great point. And I think you can learn so much from what people do in different regions and their experiences. But I think there are, I would argue that there are, you know, certain principles and tenets that I think cut across all, no pun intended, cut across all specialties and situations, which I do think people need to be cognizant of and keep in mind.

Dr Wiechmann: Sure. Yeah, there are definitely some basic tenets when we're dealing with the PAD patients and even within the PAD patient population, specifically the CLTI patient population. And as you mentioned before in your introduction, you've been part of 3 major health care systems. I'm sure you've seen some things that work in one place that won’t work in another. That's what attendees can learn from, that, okay, you're practicing in one health system or in one particular group, here's what you can take that is a common thread across every practice environment. And here's the things that maybe you're going to have to apply in a different way or you're going to have to work with different people. And I think that that's part of the learning experience and again, part of the networking and part of the humility that you have to have as an attendee and as a faculty member, learn from the people that have done this and it has worked or maybe they tried this and it hasn't worked. 

Dr Neville: That's right. Exactly right. 

Dr Wiechmann: Okay, you know another aspect, Rich, that I think the attendees really gain a lot from and also experience with is the hands-on workshops that have always been a part of AMP and in particular things like teaching access with the cadaver lab that we're offering again this year. 

Dr Neville: Yeah, that's an outstanding feature, Bret. I don't know of too many meetings that have the extent and the really outstanding hands-on workshops, especially the cadaver lab. That's fairly unique to most meetings I've ever attended. So I think that'll be really fun and I think people will learn a lot. And you remember, Bret, there's also a day dedicated to deep venous arterialization. I think, as I understand it, I think you can register for both segments of the meeting or just come for the deep venous arterialization day, which I don't know about you, but I tell you, it's an increasing part of my practice. We're doing more. Now, I think we still need to refine it a little bit and really decide who this is best for and who it's not. We've got both a surgical experience and an endo experience. I won't present that as an abstract next year [laughing]. But I think it's really a fascinating topic. Everybody's talking about it. I was operating yesterday with a resident, and this is a tough case. It's a tough tibial bypass. And the resident says to me, why don't we do a DVA?

Dr Wiechmann: There you go. 

Dr Neville: I'm like, oh wait, calm down, calm down. You know it really has caught people's attention, as it should. So I'm real excited to see how this day goes.

Dr Wiechmann: It was actually extremely well attended, last year's first DVA day, and I wasn't able to attend last year due to a previous commitment. I'm sorry that that didn't work out, but it was extremely well attended. I share your opinion that this is a technique or a procedure that needs some sorting out. It's all about patient selection just like so many things that we do, but a rock star faculty that has tremendous experience across the board with not just the technique but those specific topics: patient selection, what about follow-up, what about salvaging it if it goes down, all those things are critically important if you're going to incorporate it into your practice. And so a focus on setting aside a specific day, I think for the content is great, even though it will be mixed in along the way through the rest of the course, but having a specific day is great. 

Dr Neville: Well, let me tell you, and having done this both open and endovascularly, I think this procedure, deep venous arterialization, has as many tips and tricks as anything I've ever done. I mean there are some things you just have to learn by experience almost. So people will learn stuff on this day. There are tricks and tips that I don't think you would think of unless you've done it. I'm looking forward to it. I'll take all the tips I can get. It's really a fascinating procedure. I think it's going to certainly play a role in our armamentarium as we refine things, but I'm really excited about the learning on that day.

Dr Wiechmann: Anything else you want to add, Rich? I can't think of anything else to add.

Dr Neville: I'm just really excited to work with you, Bret. I'm really excited about the opportunity for us to take, like I said, this great foundation and really try to elevate the medium. We're going to try to enhance the academic, so to speak, quality of the lectures so people get good information, but to all the great points you raised. I'm really excited about it. I think this year's meeting will be outstanding. 

And as you mentioned, just without divulging too much, I think we might be looking at a different venue in years to come. So it's always been in the same venue, which is a beautiful place and it's great, but we're going to try to move around a little bit and make it a little attractive for  people just to come to different locations, too. So we're all excited about this year's meeting and working with you moving forward, Bret. 

Dr Wiechmann: Sounds great. We'll see you in August.

Dr Neville: Sounds good.

That does it for this episode of Vascular Voices. Thank you to Dr Wiechmann and Dr Neville for being our guests. To learn more about the Amputation Prevention Symposium and to register, visit amptheclimeeting.ccom. To find more podcast episodes, visit our website at vasculardiseasemanagement.com, or you can find us on Apple Podcasts and Spotify. Thanks for listening.