Diagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC
|
|
- Marshall Ellis
- 6 years ago
- Views:
Transcription
1 Diagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC Interventional Cardiologist/Endovascular Specialist Bradenton Cardiology Center Bradenton, FL, USA
2 Disclosures Speaker s Bureau: Astra Zeneca Abbott Vascular Volcano Corporation Spectranetics Maquet Reflow Medical Consultant: Penumbra Spectranetics Grant/Research Support: Spectranetics Bard Medtronic Veryan Medical Terumo Cordis Reflow Medical Medical/Scientific Boards: Boston Scientific Abbott Vascular
3 PAD Outcomes Hirsch AT, et al. Circulation. 2006;113:e
4 Survival (%) PAD Outcomes Normal subjects Asymptomatic PAD Symptomatic PAD Severe symptomatic PAD Year Resnick, H. E. et al. Circulation. 2004;109:
5 Incidence of Death per 1000 Patient Years PAD Outcomes n=4393 Nondiabetic IFG Diabetic < to 1.40 >1.4 Ankle-Brachial Index Mortality DM and CLI OR 2.38, P < Resnick, H. E. et al. Circulation. 2004;109: Vrsalovic M, et al. Clin Cardiol. Impact of diabetes on mortality in peripheral artery disease: a meta-analysis (5):
6 Diagnosis: Various Modalities Resting Ankle Brachial Index/Toe Brachial Index Perfusion Testing TCPO 2 (< 30 mm Hg)- Useful for HBO Fluorescence i.e. SpyElite Handheld Doppler Exercise Ankle Brachial Index Segmental Pressures Pulse Volume Recordings Arterial Duplex CT Angiogram with Runoff MR Angiogram with Runoff Invasive Angiography (Contrast/CO2 Angiography)
7 Diagnosis: Toe Brachial Index The toe-brachial index (TBI) is calculated by dividing the toe pressure by the higher of the two brachial pressures. TBI values remain accurate when ABI values are not possible due to noncompressible pedal pulses. TBI values 0.7 are usually considered diagnostic for lower extremity PAD. Toe Pressure < 55 mm Hg Consistent with Ischemic Ulcers Hirsch AT, et al. J Am Coll Cardiol. 2006;47:e1-e192. Figure 6.
8 Treatment SMOKING CESSATION CLI is often a smoker s disease Progression is guaranteed with ongoing abuse Hypertension Control Goal <140/90; <130/80 in CKD and Diabetics Use ACE-I if possible Beta blockers are not contraindicated Tight Lipid Control LDL < 100 mg/dl in all patients LDL < 70 mg/dl in patients with high risk of ischemic events
9 Treatment Glycemic Control in Diabetics Affects treatment success and patency rates A1C > 6.9% associated with increased risk of amputation Exercise Program If the patients do not move, they will lose the limb Difficult as many patients are not ambulatory with their wounds Antiplatelet Therapy ASA mg Plavix 75 mg Cilostazol 100 mg BID Combination cilostazol/plavix increases endothelial progenitor cells (p < 0.003) and improves ulcer healing (p < 0.01) Endovascular or Open Revascularization Takahara M. The influence of glycemic control on the prognosis of Japanese patients undergoing percutaneous transluminal angioplasty for critical limb ischemia. Diabetes Care Dec;33(12): Sheu JJ. Levels and values of lipoprotein-associated phospholipase A2, galectin-3, RhoA/ROCK, and endothelial progenitor cells in critical limb ischemia: pharmaco-therapeutic role of cilostazol and clopidogrel combination therapy. J Transl Med. 2014;12:101.
10 Percentage change from baseline MWD (mean) Treatment: Adjunctive Agents Cilostazol 100 mg 2 times/day (n=227) Pentoxifylline 400 mg 3 times/day (n=232) Placebo (n=239) * MWD=maximal walking distance. *P<.001 vs pentoxifylline Treatment (weeks) Dawson DL et al. Am J Med. 2000;109:
11 Treatment: Endovascular vs. Surgical Inflow Procedure Operative Mortality (%) Expected Patency Rate at Follow-up (%) Follow-up Aortobifemoral bypass years Aortoiliac or Aortofemoral bypass years Iliac endarterectomy years Femorofemoral bypass years Axillofemoral bypass years Axillofemoral-femoral bypass years Femorotibial bypass (vein) years Femorotibial bypass (PTFE) years Hirsch AT, et al. J Am Coll Cardiol. 2006;47:e1-e192. Veith FJ et al. Six-year prospective multicenter randomized comparison of autologous saphenous vein and expanded polytetrafluoroethylene grafts in infrainguinal arterial reconstructions. J Vasc Surg. 1986; 3(1):104-14
12 Treatment: Endovascular vs. Surgical Primary Patency (%, 95% CI) Iliac PTA Iliac Stent Femoropopliteal PTA Femoropopliteal Stent Infra- Popliteal PTA Mean 1-year data 2-year data 3-year data 4-year data 5-year data Hirsch AT, et al. J Am Coll Cardiol. 2006;47:e1-e192. Updated to Include MAJESTIC data for Eluvia DES
13 Angiosome Concept Direct Flow Associated with Better Outcomes- Especially in the Absence of Adequate Collaterals Improved Wound Healing (RR 0.60) Major Amputation (RR 0.56) Amputation-free Survival Rates (RR 0.83) Jongsma H. Angiosome-directed revascularization in patients with critical limb ischemia. J Vasc Surg. 2017;65(4):
14 Case Example #1 70 Year old Man Nonhealing Diabetic Ulcer of the Hallux for Over 6 Months Multiple Risk Factors Diabetic Hypertensive Smoker Rutherford 6
15 Initial Angiogram Antegrade Access into the AT- Unable to Cross the DP CTO Direct PT Access Spasm Addressed with Vasodilators
16 Initial Angiogram Identify the Occluded Plantar- Pedal Loop (Arch Reconstruction) Cross with MicroES 14 and CommandES + Fielder XT Coronary Crossing Catheters and Wires Are Useful
17 Initial Angiogram Reversed the Access and Now Wired from AT Can Cross with Wire of Choice (I Crossed with an Glidewire Advantage)
18 Initial Angiogram Reversed the Access and Now Wired from AT Can Cross with Wire of Choice (I Crossed with an Glidewire Advantage) Changed out to Wire and Used a 3.0 mm Coyote Balloon
19 Initial Angiogram Pedal Arch Flow Restored
20 Initial Angiogram Pedal Arch Flow Restored Straight Line Flow to Hallux Wound Healed Within 2 Weeks
21 Case Example #2 75 Year old Man Nonhealing Ulcer of the Right Lateral Forefoot Prior Fem-Fem Bypass Known Occluded Right Iliac Multiple Risk Factors Diabetic Hypertensive CKD Prior Smoker Rutherford 6
22 Initial Angiogram Accessed the Fem-Fem Severe SFA Stenosis Seen Single Vessel Runoff Via Peroneal to Anterior Comm Branch to AT/DP
23 Initial Angiogram Accessed the Fem-Fem Severe SFA Stenosis Seen Single Vessel Runoff Via Peroneal to Anterior Comm Branch to AT/DP
24 Initial Angiogram Accessed the Fem-Fem Severe SFA Stenosis Seen Single Vessel Runoff Via Peroneal to Anterior Comm Branch to AT/DP
25 Treat Inflow 2.0 mm TE to the SFA 6 x 200 Angiosculpt and DCB
26 Retro Crossing Selective Angio of the Peroneal Show Communicating Branch Access with 135 mm Corsair and Externalize Command ES Wire Via Retrograde up AT 1.4 mm TE Laser Antegrade
27 Retro Crossing Selective Angio of the Peroneal Show Communicating Branch Access with 135 mm Corsair and Externalize Command ES Wire Via Retrograde up AT 1.4 mm TE Laser Antegrade
28 Retro Crossing Selective Angio of the Peroneal Show Communicating Branch Access with 135 mm Corsair and Externalize Command ES Wire Via Retrograde up AT 1.4 mm TE Laser Antegrade
29 Retro Crossing Selective Angio of the Peroneal Show Communicating Branch Access with 135 mm Corsair and Externalize Command ES Wire Via Retrograde up AT 1.4 mm TE Laser Antegrade
30 Final Angiogram
31 Diagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC Interventional Cardiologist/Endovascular Specialist Bradenton Cardiology Center Bradenton, FL, USA
PAD and CRITICAL LIMB ISCHEMIA: EVALUATION AND TREATMENT 2014
PAD and CRITICAL LIMB ISCHEMIA: EVALUATION AND TREATMENT 2014 Van Crisco, MD, FACC, FSCAI First Coast Heart and Vascular Center, PLLC Jacksonville, FL 678-313-6695 Conflict of Interest Bayer Healthcare
More informationDisclosures. Talking Points. An initial strategy of open bypass is better for some CLI patients, and we can define who they are
An initial strategy of open bypass is better for some CLI patients, and we can define who they are Fadi Saab, MD, FASE, FACC, FSCAI Metro Heart & Vascular Metro Health Hospital, Wyoming, MI Assistant Clinical
More informationPeripheral arterial disease for primary care Ed Aboian, MD
Peripheral arterial disease for primary care Ed Aboian, MD Division of Vascular and Endovascular Surgery Palo Alto Medical Foundation, Burlingame Ca Disclosures Nothing to disclose Clinical presentation
More informationJohn E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,
More informationInterventional Treatment First for CLI
Interventional Treatment First for CLI Patrick Alexander, MD, FACC, FSCAI Interventional Cardiology Medical Director, Critical Limb Clinic Providence Heart Institute, Southfield MI 48075 Disclosures Consultant
More informationPATIENT SPECIFIC STRATEGIES IN CRITICAL LIMB ISCHEMIA. Dr. Manar Trab Consultant Vascular Surgeon European Vascular Clinic DMCC Dubai, UAE
PATIENT SPECIFIC STRATEGIES IN CRITICAL LIMB ISCHEMIA Dr. Manar Trab Consultant Vascular Surgeon European Vascular Clinic DMCC Dubai, UAE Disclosure Speaker name: DR. Manar Trab I have the following potential
More informationLarry Diaz, MD, FSCAI Mehdi H. Shishehbor, DO, FSCAI
PAD Diagnosis Larry Diaz, MD, FSCAI Metro Health / University of Michigan Health, Wyoming, MI Mehdi H. Shishehbor, DO, FSCAI University Hospitals Harrington Heart & Vascular Institute, Cleveland, OH PAD:
More informationIntercepting PAD. Playbook for Cardiovascular Care 2018 February 24, Jonathan D Woody, MD, FACS. University Surgical Vascular
Intercepting PAD Playbook for Cardiovascular Care 2018 February 24, 2018 Jonathan D Woody, MD, FACS University Surgical Vascular Attending Vascular Surgeon - Piedmont Athens Regional Adjunct Clinical Associate
More informationComparison Of Primary Long Stenting Versus Primary Short Stenting For Long Femoropopliteal Artery Disease (PARADE)
Comparison Of Primary Long Stenting Versus Primary Short Stenting For Long Femoropopliteal Artery Disease (PARADE) Young-Guk Ko, M.D. Severance Cardiovascular Hospital, Yonsei University Health System,
More informationOrbital Atherectomy. S. Jay Mathews, MD, MS, FACC Interventional Cardiologist, Bradenton Cardiology Center
Orbital Atherectomy S. Jay Mathews, MD, MS, FACC Interventional Cardiologist, Bradenton Cardiology Center Disclosures Clinical Investigator/Research Support Spectranetics, Terumo, Cordis, Abbott Vascular,
More informationForget about the angiosome theories. Yann Gouëffic, MD, PhD Department of vascular surgery, institut du thorax, Nantes, France
Forget about the angiosome theories Yann Gouëffic, MD, PhD Department of vascular surgery, institut du thorax, Nantes, France Disclosure of Interest Research grants /Consulting/Honoraria for - Abbott -
More informationPeripheral Artery Disease Interventions Utilizing the Angiosomal Approach to the Complex Wound
Peripheral Artery Disease Interventions Utilizing the Angiosomal Approach to the Complex Wound Craig M. Walker, MD, FACC, FACP Chairman, New Cardiovascular Horizons Clinical Professor of Medicine Tulane
More informationManaging Conditions Resulting from Untreated Cardiometabolic Syndrome
Managing Conditions Resulting from Untreated Cardiometabolic Syndrome Matthew P. Namanny DO, FACOS Vascular/Endovascular Surgery Saguaro Surgical/AZ Vascular Specialist Tucson Medical Center Critical Limb
More informationCurrent Status of Endovascular Therapies for Critical Limb Ischemia
Current Status of Endovascular Therapies for Critical Limb Ischemia Bulent Arslan, MD Associate Professor of Radiology Director, Vascular & Interventional Radiology Rush University Medical Center bulent_arslan@rush.edu
More informationHybrid Procedures for Peripheral Obstructive Disease - Step by Step -
Hybrid Procedures for Peripheral Obstructive Disease - Step by Step - Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery Disclosure Speaker name:..holger Staab... I have
More informationGuidelines for Management of Peripheral Arterial Disease
Guidelines for Management of Peripheral Arterial Disease Subhash Banerjee, MD, FACC, FSCAI Professor of Medicine, Univ. of Texas Southwestern Medical Center Chief, Division of Cardiology, VA North Texas
More information6/6/2016. Pedal Loop Reconstruction: A Crash Course in 60 minutes. Pedal-Plantar Anatomy. Anand Prasad, MD, FACC, FSCAI, RPVI.
6/6/2016 Pedal Loop Reconstruction: A Crash Course in 60 minutes Pedal-Plantar Anatomy Anand Prasad, MD, FACC, FSCAI, RPVI Associate Professor of Medicine Freeman Heart Association Endowed Professor in
More informationWhat s New in the Management of Peripheral Arterial Disease
What s New in the Management of Peripheral Arterial Disease Sibu P. Saha, MD, MBA Professor of Surgery Chairman, Directors Council Gill Heart Institute University of Kentucky Lexington, KY Disclosure My
More informationPerfusion Assessment in Chronic Wounds
Perfusion Assessment in Chronic Wounds American Society of Podiatric Surgeons Surgical Conference September 22, 2018 Michael Maier, DPM, FACCWS Cardiovascular Medicine Cleveland Clinic Disclosures Speaker,
More informationHow Do We Optimize the Medical Therapy of Patients with Critical Limb Ischemia?
How Do We Optimize the Medical Therapy of Patients with Critical Limb Ischemia? Ehrin J. Armstrong, MD MSc MAS Director, Interventional Cardiology Director, Vascular Laboratory VA Eastern Colorado Healthcare
More informationEndovascular Intervention BtK Intervention in Patients with Chronic Dialysis
Endovascular Intervention BtK Intervention in Patients with Chronic Dialysis GB Danzi, MD Ospedale Maggiore Policlinico Milan Italy Disease Pattern in PAD Hypercholesterolemia Age ESRD Current smoking
More information9/7/2018. Disclosures. CV and Limb Events in PAD. Challenges to Revascularization. Challenges. Answering the Challenge
Disclosures State-of-the-Art Endovascular Lower Extremity Revascularization Promotional Speaker Jansen Pharmaceutical Promotional Speaker Amgen Pharmaceutical C. Michael Brown, MD, FACC al Cardiology Associate
More informationCopyright HMP Communications
Ocelot With Wildcat in a Complicated Superficial Femoral Artery Chronic Total Occlusion Soundos K. Moualla, MD, FACC, FSCAI; Richard R. Heuser, MD, FACC, FACP, FESC, FSCAI From Phoenix Heart Center, Phoenix,
More informationWhen is below-the-ankle angioplasty indicated and how to introduce it into your practice. Roberto Ferraresi. Peripheral Interventional Unit
When is below-the-ankle angioplasty indicated and how to introduce it into your practice Roberto Ferraresi Peripheral Interventional Unit Bergamo Italy www.robertoferraresi.it Disclosure Roberto Ferraresi,
More informationCritical Limb Ischemia A Collaborative Approach to Patient Care. Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017
Critical Limb Ischemia A Collaborative Approach to Patient Care Christopher LeSar, MD Vascular Institute of Chattanooga July 28, 2017 Surgeons idea Surgeons idea represents the final stage of peripheral
More informationPeripheral Arterial Disease: Who has it and what to do about it?
Peripheral Arterial Disease: Who has it and what to do about it? Seth Krauss, M.D. Alaska Annual Nurse Practitioner Conference September 16, 2011 Scope of the Problem Incidence: 20%
More informationCurrent Vascular and Endovascular Management in Diabetic Vasculopathy
Current Vascular and Endovascular Management in Diabetic Vasculopathy Yang-Jin Park Associate professor Vascular Surgery, Samsung Medical Center Sungkyunkwan University School of Medicine Peripheral artery
More informationPractical Point in Holistic Diabetic Foot Care 3 March 2016
Diabetic Foot Ulcer : Vascular Management Practical Point in Holistic Diabetic Foot Care 3 March 2016 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai
More informationStratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI?
Stratifying Management Options for Patients with Critical Limb Ischemia: When Should Open Surgery Be the Initial Option for CLI? Peter F. Lawrence, M.D. Gonda Vascular Center Division of Vascular Surgery
More informationPractical Point in Diabetic Foot Care 3-4 July 2017
Diabetic Foot Ulcer : Role of Vascular Surgeon Practical Point in Diabetic Foot Care 3-4 July 2017 Supapong Arworn, MD Division of Vascular and Endovascular Surgery Department of Surgery, Chiang Mai University
More informationCritical Limb Ischemia: Diagnosis and Current Management
Research Article Joseph Karam, MD Elliot J. Stephenson, MD From: Minneapolis Heart Institutet at Abbott Northwestern Hospital, Minneapolis, MN Address for correspondence: Joseph Karam, MD Minneapolis Heart
More informationAngiosome concept myth or truth? Does it make a real difference in real world cases?
Angiosome concept myth or truth? Does it make a real difference in real world cases? Osamu Iida, MD, FACC Kansai Rosai Hospital Amagasaki, Hyogo, Japan Disclosure Speaker name:... I have the following
More informationTreatment Strategies For Patients with Peripheral Artery Disease
Treatment Strategies For Patients with Peripheral Artery Disease Presented by Schuyler Jones, MD Duke University Medical Center & Duke Clinical Research Institute AHRQ Comparative Effectiveness Review
More informationDisclosures. Tips and Tricks for Tibial Intervention. Tibial intervention overview
Tips and Tricks for Tibial Intervention Donald L. Jacobs, MD C Rollins Hanlon Endowed Professor and Chair Chair of Surgery Saint Louis University SSM-STL Saint Louis University Hospital Disclosures Abbott
More informationImaging Strategy For Claudication
Who are the Debators? Imaging Strategy For Claudication Duplex Ultrasound Alone is Adequate to Select Patients for Endovascular Intervention - Pro: Dennis Bandyk MD No Disclosures PRO - Vascular Surgeon
More informationDistal By-Pass procedures can reduce limb loss
Conventional treatment of the diabetic foot Distal By-Pass procedures can reduce limb loss Dr. Nikolaos Melas, PhD Vascular and Endovascular Surgeon Military Doctor Associate in 1st department of Surgery,
More informationDisclosures. Critical Limb Ischemia. Vascular Testing in the CLI Patient. Vascular Testing in Critical Limb Ischemia UCSF Vascular Symposium
Disclosures Vascular Testing in the CLI Patient None 2015 UCSF Vascular Symposium Warren Gasper, MD Assistant Professor of Surgery UCSF Division of Vascular Surgery Critical Limb Ischemia Chronic Limb
More informationCritical limb ischemia due to an occlusion of an aorto-biiliac prothesis step by step case presentation and decision making
Critical limb ischemia due to an occlusion of an aorto-biiliac prothesis step by step case presentation and decision making Dr. Özgün Sensebat Vascular and general surgeon Vascular Private Clinic Dorsten
More informationIntroduction. Risk factors of PVD 5/8/2017
PATHOPHYSIOLOGY AND CLINICAL FEATURES OF PERIPHERAL VASCULAR DISEASE Dr. Muhamad Zabidi Ahmad Radiologist and Section Chief, Radiology, Oncology and Nuclear Medicine Section, Advanced Medical and Dental
More informationSurgery is and Remains the Gold Standard for Limb-Threatening Ischemia
Surgery is and Remains the Gold Standard for Limb-Threatening Ischemia Albeir Mousa, MD., FACS.,MPH., MBA Professor of Vascular and Endovascular Surgery West Virginia University Disclosure None What you
More informationStep by step Hybrid procedures in peripheral obstructive disease. Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery
Step by step Hybrid procedures in peripheral obstructive disease Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery Disclosure Speaker name: H.H. Staab I have the following
More informationI am no good at debates!
Disclosure Statement of Financial Interest Imaging Strategy for Claudication: Ultrasound Alone is Not Adequate to Select Patients for Endovascular Intervention Within the past 12 months, I or my spouse/partner
More informationAggressive BTK Revascularization and Advanced Wound Care - Patient Specific Therapy Concepts
Aggressive BTK Revascularization and Advanced Wound Care - Patient Specific Therapy Concepts Dr Steven Kum MBBS MMed FRCS FAMS Vascular & Endovascular Surgeon Vascular Centre Department of Surgery Changi
More informationIntroduction to Peripheral Arterial Disease. Stacey Clegg, MD Interventional Cardiology August
Introduction to Peripheral Arterial Disease Stacey Clegg, MD Interventional Cardiology August 20 2014 Outline (and for the ABIM board exam * ** ***) Prevalence* Definitions Lower Extremity: Aorta*** Claudication***
More informationBoca Raton Regional Hospital Grand Rounds September 13, 2016
Boca Raton Regional Hospital Grand Rounds September 13, 2016 W. Anthony Lee, MD, FACS Chief, BocaCare Vascular Surgery Christine E. Lynn Heart and Vascular Institute Boca Raton, Florida Disclosures No
More informationAccess strategy for chronic total occlusions (CTOs) is crucial
Learn How Access Strategy Impacts Complex CTO Crossing Arthur C. Lee, MD The Cardiac & Vascular Institute, Gainesville, Florida VASCULAR DISEASE MANAGEMENT 2018;15(3):E19-E23. Key words: chronic total
More informationEndovascular Therapy vs. Open Femoral Endarterectomy Rationale and Design of the Randomized PESTO Trial
Endovascular Therapy vs. Open Femoral Endarterectomy Rationale and Design of the Randomized PESTO Trial Prof. Thomas Zeller, MD Department Angiology Clinic for Cardiology and Angiology II University Heart-Center
More informationObjective assessment of CLI patients Hemodynamic parameters
Objective assessment of CLI patients Hemodynamic parameters Worth anything in end stage patients? Marianne Brodmann Angiology, Medical University Graz, Austria Disclosure Speaker name: Marianne Brodmann
More informationGarland Green, MD Interventional Cardiologist. Impact of PAD: Prevalence, Risk Factors, Testing, and Medical Management
Garland Green, MD Interventional Cardiologist Impact of PAD: Prevalence, Risk Factors, Testing, and Medical Management Peripheral Arterial Disease Affects over 8 million Americans Affects 12% of the general
More informationClinical Approach to CLI and Related Diagnostics: What You Need to Know
Clinical Approach to CLI and Related Diagnostics: What You Need to Know Ido Weinberg, MD Assistant Professor of Medicine Harvard Medical School Massachusetts General Hospital None Disclosures Critical
More informationSurgical Options for revascularisation P E T E R S U B R A M A N I A M
Surgical Options for revascularisation P E T E R S U B R A M A N I A M The goal Treat pain Heal ulcer Preserve limb Preserve life The options Conservative Endovascular Surgical bypass Primary amputation
More informationEndovascular Is The Way To Go: Revascularize As Many Vessels As You Can
Rafael Malgor, MD Assistant Professor of Surgery The University of Oklahoma, Tulsa Endovascular Is The Way To Go: Revascularize As Many Vessels As You Can Background Lower extremity anatomy (below the
More informationGlobal Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care
Global Vascular Guideline on the Management of Chronic Limb Threatening Ischemia -a new foundation for evidence-based care Michael S. Conte MD Professor and Chief, Division of Vascular and Endovascular
More informationJohn E. Campbell, MD. Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division
John E. Campbell, MD Assistant Professor of Surgery and Medicine Department of Vascular Surgery West Virginia University, Charleston Division John Campbell, MD For the 12 months preceding this CME activity,
More informationLimb Salvage in Diabetic Ischemic Foot. Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017
Limb Salvage in Diabetic Ischemic Foot Kritaya Kritayakirana, MD, FACS Assistant Professor Chulalongkorn University April 30, 2017 Case Male 67 years old Underlying DM, HTN, TVD Present with gangrene
More informationHypothesis: When compared to conventional balloon angioplasty, cryoplasty post-dilation decreases the risk of SFA nses in-stent restenosis
Cryoplasty or Conventional Balloon Post-dilation of Nitinol Stents For Revascularization of Peripheral Arterial Segments Background: Diabetes mellitus is associated with increased risk of in-stent restenosis
More informationCath Lab Essentials : Peripheral Vascular Disease in Patients with CAD
Cath Lab Essentials : Peripheral Vascular Disease in Patients with CAD Pranav M. Patel, MD, FACC, FSCAI Interim Chief & Associate Professor of Medicine Director, Cardiac Catheterization Lab University
More informationUse of Laser In BTK Disease (CLI)
Use of Laser In BTK Disease (CLI) Click to edit academic affiliation, practice or hospital logo(s) of preference. Product and/or sponsor logos not permitted, per CME guidelines. Richard Kovach, MD, FACC,
More informationThe Struggle to Manage Stroke, Aneurysm and PAD
The Struggle to Manage Stroke, Aneurysm and PAD In this article, Dr. Salvian examines the management of peripheral arterial disease, aortic aneurysmal disease and cerebrovascular disease from symptomatology
More informationHybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case
Hybrid surgical treatment of bilateral aorto-femoral occlusion: a clinical case Chernyavskiy M.,MD,PhD, Chernova D., Zherdev N., Chernov A. Almazov National Medical Research Centre, St.Petersburg, Russia
More informationFirst time data release: Initial experience with the temporary Spur Stent System: DEEPER Trial first-in-man results Jihad A. Mustapha, MD, FACC,
First time data release: Initial experience with the temporary Spur Stent System: DEEPER Trial first-in-man results Jihad A. Mustapha, MD, FACC, FSCAI Associate Professor of Medicine Michigan State University,
More informationMaking BTK Interventions more Durable: Are DES and DCB the answer? Thomas Zeller, MD
Making BTK Interventions more Durable: Are DES and DCB the answer? Thomas Zeller, MD Faculty Disclosure Thomas Zeller, MD For the 12 months preceding this presentation, I disclose the following types of
More informationDON T LET LEG PAIN BECOME A REAL THREAT.
DON T LET LEG PAIN BECOME A REAL THREAT. These three words have the power to change lives. Between 8 to 10 million Americans are estimated to suffer from poor blood flow to the legs and feet potentially
More informationPUT YOUR BEST FOOT FORWARD
PUT YOUR BEST FOOT FORWARD Bala Ramanan, MBBS 1 st year vascular surgery fellow Introduction The epidemic of diabetes and ageing of our population ensures critical limb ischemia will continue to grow.
More informationWhen and how to use distal protection devices for lower extremity revascularization. Peter A. Schneider, MD Kaiser Foundation Hospital, Honolulu
When and how to use distal protection devices for lower extremity revascularization Peter A. Schneider, MD Kaiser Foundation Hospital, Honolulu Disclosure Peter A. Schneider Potential conflicts of interest
More informationPeripheral Arterial Disease: Objectives. Disclosure. Definition: Peripheral Arterial Disease (PAD)
Geriatric Grand Rounds Tuesday, April 21, 2009 12:00 noon Dr. Bill Black Auditorium Glenrose Rehabilitation Hospital In keeping with Glenrose Rehabilitation Hospital policy, speakers participating in this
More informationFemoropopliteal Above-Knee Bypass: The True Results
Femoropopliteal Above-Knee Bypass: The True Results Lise Pyndt Jørgensen, Camilla Rasmussen & Torben V Schroeder Rigshospitalet and University of Copenhagen, DENMARK Treatment options in the femoropopliteal
More informationDevice Evolution. Atherectomy: Where Do We Stand After 12 Years Since FDA Clearance. Where Do We Stand? 4/18/2015
Disclosure Statement of Financial Interest Atherectomy: Where Do We Stand After 12 Years Since FDA Clearance Within the past 12 months, I or my spouse/partner have had a financial interest/arrangement
More informationGLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE
GLOBAL VASCULAR GUIDELINES: A NEW PATHWAY FOR LIMB SALVAGE Michael S. Conte MD Professor and Chief, Vascular and Endovascular Surgery Co-Director, Center for Limb Preservation Co-Director, Heart and Vascular
More informationIs there still any space left for DES in the BTK area??? (Angiolite BTK trial, 6 month Data)
Is there still any space left for DES in the BTK area??? (Angiolite BTK trial, 6 month Data) (Angiolite BTK DES, IVascular) P. Goverde MD, K. Taeymans MD, K. Lauwers MD Vascular Clinic ZNA Antwerp,Belgium
More informationAccess (Antegrade, Retrograde, Pedal)
Access (Antegrade, Retrograde, Pedal) ARCH St. Louis Craig M. Walker, MD, FACC, FACP Clinical Professor of Medicine Tulane University School of Medicine New Orleans, LA Clinical Professor of Medicine LSU
More informationEndovascular Approach to CTOs: Crossing methods and Devices
Endovascular Approach to CTOs: Crossing methods and Devices Anish J. Thomas, MD FACC FSCAI Interventional Cardiology Vascular/Endovascular Medicine SSM Heart Institute St. Louis, MO Disclosure Consultant:
More informationDEB in Periphery: What we Know Till Now
DEB in Periphery: What we Know Till Now Karl-Ludwig Schulte Vascular Center Berlin Ev. Hospital Königin Elisabeth St. Gertrauden Hospital Charité, CC13, Humboldt-University Berlin www.vascular-center-berlin.com
More informationNovel distal popliteal artery puncture technique in supine position for chronic femoropopliteal arterial occlusion; frontal popliteal puncture
Novel distal popliteal artery puncture technique in supine position for chronic femoropopliteal arterial occlusion; frontal popliteal puncture Miyazaki Medical Association Hospital Cardiovascular Center
More informationPeripheral Artery Disease Role of Exercise, Endovascular and Surgical Options
Peripheral Artery Disease Role of Exercise, Endovascular and Surgical Options Jeffrey W. Olin, D.O., F.A.C.C., F.A.H.A. Professor of Medicine (Cardiology) Director of Vascular Medicine & the Vascular Diagnostic
More informationAppropriate Device Selection for Endovascular Procedures
Appropriate Device Selection for Endovascular Procedures Thomas M. Shimshak, MD Florida Hospital Heartland Medical Center Sebring, Florida Disclosures Speaker s Bureau: Abbott Vascular Boston Scientific
More informationDCB in my practice: How the evidence influences my strategy. Yang-Jin Park
DCB in my practice: How the evidence influences my strategy Yang-Jin Park Associate Professor Division of Vascular Surgery, Department of Surgery Samsung Medical Center Sungkyunkwan University School of
More informationUpdate on Tack Optimized Balloon Angioplasty (TOBA) Below the Knee. Marianne Brodmann, MD Medical University Graz Graz, Austria
Update on Tack Optimized Balloon Angioplasty (TOBA) Below the Knee Marianne Brodmann, MD Medical University Graz Graz, Austria Critical Limb Ischemia Infrapopliteal arterial disease is a leading source
More informationThe relation of 2D perfusion angiography after BTK intervention and wound healing in patient with CLI - Single center prospective study -
The relation of 2D perfusion angiography after BTK intervention and wound healing in patient with CLI - Single center prospective study - Shinya Sasaki, MD. Saka General Hospital Miyagi, JAPAN Disclosure
More informationChristian Wissgott MD, PhD Assistant Director, Radiology Westküstenkliniken Heide
2-Year Results Of The Tack Optimized Balloon Angioplasty (TOBA) Trial For Fem- Pop Lesions Demonstrates Safety and Efficacy Of The Tack Endovascular System In Repairing Focal Post-PTA Dissections Christian
More informationIndex. cardiology.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A ABI. See Ankle-brachial index (ABI). Afterload, deconstructing of, in ventricular vascular interaction in heart failure, 449 Air plethysmography
More informationThe Burden of CLI and Crosser Catheter Recanalization Strategies
, LLC an HMP Communications Holdings Company November 2013 Volume 25/ Supplement D www.invasivecardiology.com The Official Journal of the International Andreas Gruentzig Society The Burden of CLI and Crosser
More informationRole of ABI in Detecting and Quantifying Peripheral Arterial Disease
Role of ABI in Detecting and Quantifying Peripheral Arterial Disease Difference in AAA size between US and Surgeon 2 1 0-1 -2-3 0 1 2 3 4 5 6 7 Mean AAA size between US and Surgeon Kathleen G. Raman MD,
More informationAnatomy-Driven Endograft Selection for Abdominal Aortic Aneurysm Repair S. Jay Mathews, MD, MS, FACC
Anatomy-Driven Endograft Selection for Abdominal Aortic Aneurysm Repair S. Jay Mathews, MD, MS, FACC Interventional Cardiologist/Endovascular Specialist Bradenton Cardiology Center Bradenton, FL, USA Disclosures
More informationDCB use in fem-pop lesions of patients with CLI (RCC 4-5): subgroup analysis of IN.PACT Global 12-month outcomes
DCB use in fem-pop lesions of patients with CLI (RCC 4-5): subgroup analysis of IN.PACT Global 12-month outcomes Carlos Mena, MD FACC FSCAI Associate Professor of Medicine - Cardiology Director Cardiac
More informationLIMB SALVAGE IN THE DIABETIC PATIENT
LIMB SALVAGE IN THE DIABETIC PATIENT WHO? HOW? BEST? DISCLOSURES Educational grant from Cook Inc OBJECTIVES Review risk stratification and staging schemes for the threatened limb Discuss current concepts
More informationFor Personal Use. Copyright HMP 2013 J INVASIVE CARDIOL 2013;25(5):E96-E100
Case Report and Brief Review Transcollateral Approach for Percutaneous Revascularization of Complex Superficial Femoral Artery Chronic Total Occlusion Zaheed Tai, DO ABSTRACT: Chronic total occlusions
More informationPeripheral Arterial Disease. Westley Smith MD Vascular Fellow
Peripheral Arterial Disease Westley Smith MD Vascular Fellow Background (per 10,000) Goodney P, et al. Regional intensity of vascular care and lower extremity amputation rates. JVS. 2013; 6: 1471-1480.
More informationThe ZILVERPASS study a randomized study comparing ZILVER PTX stenting with Bypass in femoropopliteal lesions
The ZILVERPASS study a randomized study comparing ZILVER PTX stenting with Bypass in femoropopliteal lesions Dr. Sven Bräunlich Department of Angiology University-Hospital Leipzig, Germany Disclosure Speaker
More informationEvidence-Based Optimal Treatment for SFA Disease
Evidence-Based Optimal Treatment for SFA Disease Endo first Don t burn surgical bridge Don t stent if possible Javairiah Fatima, MD Assistant Professor of Surgery Division of Vascular and Endovascular
More informationRecent Advances in Peripheral Salvage
Recent Advances in Peripheral Salvage Dr Shaiful Azmi Yahaya, MD, MMed, FNHAM, FAsCC, FAPSIC Consultant Cardiologist and Peripheral Interventionist, Institut Jantung Negara Disclosure I am proctoring for
More informationEndovascular Should Be Considered First Line Therapy
Revascularization of Patients with Critical Limb Ischemia Endovascular Should Be Considered First Line Therapy Michael Conte David Dawson David L. Dawson, MD Revised Presentation Title A Selective Approach
More informationPeripheral Vascular Disease
Peripheral artery disease (PAD) results from the buildup of plaque (atherosclerosis) in the arteries of the legs. For people with PAD, symptoms may be mild, requiring no treatment except modification of
More informationNorth American Society of Cardiovascular Imaging Annual Meeting, Baltimore MD, October 15-18, Tips and Tricks in Vascular Imaging
North American Society of Cardiovascular Imaging Annual Meeting, Baltimore MD, October 15-18, 2016 Tips and Tricks in Vascular Imaging Lower Extremity CTA Dominik Fleischmann, Richard Hallett Division
More informationLeft Superficial Femoral Artery Occlusion in a Patient With an Aortobifemoral Graft
WHAT WOULD YOU DO? Left Superficial Femoral Artery Occlusion in a Patient With an Aortobifemoral Graft MODERATOR: EHRIN J. ARMSTRONG, MD PANEL: STEVE HENAO, MD, FACC, FACS; SAHIL A. PARIKH, MD, FACC, FSCAI;
More informationSAFETY AND EFFECTIVENESS OF ENDOVASCULAR REVASCULARIZATION FOR PERIPHERAL ARTERIAL OCCLUSIONS
SAFETY AND EFFECTIVENESS OF ENDOVASCULAR REVASCULARIZATION FOR PERIPHERAL ARTERIAL OCCLUSIONS LIBBY WATCH, MD MIAMI VASCULAR SPECIALISTS MIAMI CARDIAC & VASCULAR INSTITUTE FINANCIAL DISCLOSURES None 2
More informationSafety and Efficacy of Distal Superficial Femoral Artery Puncture for Femoropopliteal Occlusive Lesions
Safety and Efficacy of Distal Superficial Femoral Artery Puncture for Femoropopliteal Occlusive Lesions ~Result form the Multicenter RIVERside registry~ Tatsuya Nakama, Y Yamamoto, A Matsui, T Doijiri,
More informationDistal hybrids - an option in long SFA CTO accompanied by severely compromized crural runoff
Distal hybrids - an option in long SFA CTO accompanied by severely compromized crural runoff P. Kuryanov, A. Lipin, A. Antropov, K. Atmadzas, A. Atmadzas, Y. Eminov, A. Borisov, R. Sobolev, A.Orlov Limb
More informationVascular Surgery Cases: Detours. Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists
Vascular Surgery Cases: Detours Brian F. Stull, RDMS, RVT UNC REX Healthcare Vascular Specialists Brian.Stull@Unchealth.unc.edu Objectives Anatomy of a bypass graft Where does it connect, where does it
More information