Endovascular treatment of severe TASC C and D external iliac artery occlusive disease. SAINT-LEBES Bertrand Toulouse FRANCE
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1 Endovascular treatment of severe TASC C and D external iliac artery occlusive disease SAINT-LEBES Bertrand Toulouse FRANCE
2 Disclosure Speaker name: SAINT-LEBES I have the following potential conflicts of interest to report: Consulting Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest
3 External iliac artery obstructive disease TASC C Bilateral EIA stenoses 3-10 cm long not extending into the CFA Unilateral EIA stenosis extending into the CFA Unilateral EIA occlusion that involves the origins of internal iliac and/or CFA TASC D Diffuse disease involving the aorta and both iliac arteries Diffuse multiple stenoses involving the unilateral CIA, EIA and CFA Unilateral occlusions of both CIA and EIA Bilateral occlusions of EIA
4 Bravissimo Trial Between July 2009 and September patients with TASC C and D aorto iliac lesions Endovascular therapy may be considered the preferred first-line treatment option of iliac 100% technical succes lesions irrespectively of TASC lesion category. 24M primary patency rate TASC C: 91.9% TASC D: 84.8%
5 Vascular stent design matters Stent design should accommodate natural anatomic forces Goal: allow arteries to maintain as much natural behavior and function Dynamic forces of the EIA require a compliant stent to minimize chronic vessel injury and stresses on stent that can lead to fracture
6 Stent fractures significantly influenced the patency of the stented segment No-fractured stents Fractured stents Scheinert D et al. Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol Jan 18; 45 (2):
7 TIGRIS
8 Unique Dual-Component Stent Design Designed to: Maximize flexibility while minimizing risk of stent fracture Allow axial compression while resisting stent elongation Naturally conforms and allows vessel movement GORE and designs are trademarks of W. L. Gore & Associates W. L. Gore & Associates, Inc..
9 Dual-Component Stent Design (Nitinol+ePTFE) Carmedia bioactive surface (Heparin Bonding) GORE and designs are trademarks of W. L. Gore & Associates W. L. Gore & Associates, Inc..
10 Device information Unlocking the delivery system owhen unlocking the catheter will advance 0.5cm oreposition before deployment Lengths: 30, 40, 60, 80, 100mm Catheter Lengths: 80, 120cm
11 CLINICAL CASES
12 Case 1 Mr P 55 Y, Male Risk Factors: Tobacco use, Dyslipidemia, obesity Rutherford III, ABI 0,71 TASC D Ttt 25/06/2014
13 TASC D
14 Tigris 7x80
15
16 Case 2 Mr A 60 Y, Male Risk Factors: Tobacco use, Dyslipidemia Rutherford III, ABI 0,6 TASC C Ttt 07/01/2014
17 TASC C
18 Tigris 7x80mm
19 Tigris 7x60mm
20 Case 3 Mr H 47 Y, Male Risk Factors: Tobacco use, Obesity, HT Rutherford III, ABI 0,61 TASC D Ttt 27/02/2014
21 TASC D
22
23
24 Tigris 7x100mm
25
26
27 Case 4 Mr P 75 Y, Male Risk Factors: Tobacco stopped, Obesity, dyslipidemia Rutherford III, ABI 0,68 TASC C Ttt 09/04/2014
28 TASC C
29 Tigris 7x40mm
30
31 Case 5
32
33 CLINICAL DATA
34 Our Results From 10/2012 to 12/2015 Total Risk Factors N N patients 98 Limbs 106 Sex ratio (77.6%) Age 66 (46 92) Tabacco 93 (95%) Diabetis 25 (26%) Obesity 46 (47%) HTA 37 (38%) Lesions length average 80mm (40 120mm) Dyslipidemia 60 (61%) TASC C 57 (58%) TASC D 41 (42%) 8 bilateral-11 double stenting Rutherford II 20 (19%) Rutherford III 67 (63%) Rutherford IV 15 (14%) Rutherford V 4 (4%) ABI 0,63 ABI Rutherford II 0,73 ABI Rutherford III 0,65 ABI Rutherford IV 0,48 ABI Rutherford V 0,34 B. Saint-lebes and M. Sibe, JVS submission process
35 Results n=106 Total 98% at 24 M Procedures completed 100% FU 16,8 months (13 to 51) Perioperative death 1 (0,9%) Late Mortality (> M6) 2 (1,8%) Thombosis 1 (0,9%) Stenosis 4 (3,8%) Amputation 0 98% at 36 M 88% at 36 M B. Saint-lebes and M. Sibe, JVS submission process
36 Rutherford improvment
37 Conclusions Tigris is a good option treatment o Flexibility, conformability and accuracy: EIA CBAS o Avoid early thrombosis Disadvantages o Only short lengths (30-100mm) o No extremity markers Required clinical results o FU, long term results o RCT
38 Radial Force Lesion Coverage Flexibility
39 Thanks for your attention
40 Endovascular treatment of severe TASC C and D external iliac artery occlusive disease SAINT-LEBES Bertrand, MD Toulouse FRANCE
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