PATIENTS WITH CLI THE THREE YEARS OUTCOME OF ENDOLUMINAL BYPASS FOR PATIENTS WITH CLI

Transcription

1 JORGE FERNÁNDEZ NOYA ANGIOLOGY AND VASCULAR SURGERY DEPARTMENT UNIVERSITARY CLINICAL HOSPITAL SANTIAGO DE COMPOSTELA THE THREE YEARS OUTCOME OF ENDOLUMINAL BYPASS FOR

2 Disclosure Speaker name: Jorge Fernández Noya I have the following potential conflicts of interest to report: X Consulting: GORE Employment in industry Stockholder of a healthcare company Owner of a healthcare company Other(s) I do not have any potential conflict of interest

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5 Nitinol Stent Inner layer of eptfe Superb flexibility Low fractures reported in the SFA Heparin-bonded luminal surface for thrombo-resistance Actually up to 25 cm lenght

6 VIABAHN Increased trombogenicity?? Without marks in the edges. The delivery system is not precise Without enought radial force Increased number of Acute ischemia (Occlusion of collaterals)

7 LITERATURE WORLD EXPERIENCE OUR EXPERIENCE

8 ENDOLUMINAL BY-PASS Planning with Duplex-Scan or CT. Usually ipsilateral approach. Angiogram: Looking for healthy vessel proximal and distal ( 1cm) Don t cover genicular arteries Post-dilatation inside the device. Avoid Oversizing ( <20%) Follow-up is critical

9 ENDOLUMINAL BY-PASS Planning with Duplex-Scan or CT.

10 ENDOLUMINAL BY-PASS Avoid Oversizing ( <20%) Effects of Device Sizing: Proximal 91% p< % Effects of Device Sizing: Distal 87% 72% p=0.09 VIPER TRIAL

11 ENDOLUMINAL BY-PASS Angiogram: Looking for proximal and distal ( 1cm) healthy vessel

12 ENDOLUMINAL BY-PASS Don t cover genicular arteries

13 ENDOLUMINAL BY-PASS Post-dilatation inside the device.

14 OUR EXPERIENCE RetrospectIive June 2010-june Patients ( 101 Limbs ) Average Follow up 383 days % male Average age: 72.5 years old.

15 OUR EXPERIENCE 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0

16 OUR EXPERIENCE DISTAL PTA/STENT DISTAL SURGERY PROXIMAL BARE STENT PROXIMAL FEM- OPEN SURGERY NO ASSOCIATE PROCEDURE. ILIAC OPEN SURGERY ILIAC PTA/STENT 57.1% ASSOCIATE PROCEDURE

17 OUR EXPERIENCE CATEGORY 4: ISCHEMIC REST PAIN 28.5% CATEGORY 5: MINOR TISSUE LOSS 63.3% CATEGORY 6: MAJOR TISSUE LOSS 8.2%

18 OUR EXPERIENCE LESIONS CHARACTERISTICS Occlusions 78.6% Stenosis 21.4% Calcification Mild 41.8% Moderate 37.8% Severe 20.4% 58.2% Length < 10 cm 15.3% cm 32.7% >20 cm 52% Run off 0 5.1% 1 52% 84.7% 57.1% % %

19 OUR EXPERIENCE GLOBAL RESULTS Primary Patency Secondary Patency Limb Salvage Time ( Days) Time ( Days) Time ( Days) PRIMARY PATENCY SECONDARY PATENCY LIMB SALVAGE 1 YEAR 78.8 % 82.2% 88% 2 YEARS 71,7 % 74,8 % 82,1%

20 OUR EXPERIENCE DIABETES Primary Patency DIABETICS----- NON-DIABETICS---- Limb Salvage Time ( Days) PRIMARY PATENCY DIABETICS NON- DIABETICS 1 year 78.3% 79.5% 2 years 70.7% 74.2% Time ( Days) LIMB SALVAGE DIABETICS NON DIABETICS 1 year 89.8% 84.2% 2 years 80.4% 84.2%

21 OUR EXPERIENCE RUTHERFORD CATEGORY --- Rutherford 4 Primary Patency --- Rutherford Rutherford 6 Limb Salvage Time ( Days) PRIMARY PATENCY year 75.3% 83.2% 50% 2 years 75.3% 71.3% Time ( Days) LIMB SALVAGE year 94.7% 91.6% 37.5% 2 years 94.7% 85% -----

22 OUR EXPERIENCE LENGTH < 10 cm cm---- PRIMARY PATENCY <10 cm cm >20 cm 1 year 86.2% 89.4% 69.6% Primary Patency >20 cm 2 years 76.6% 89.4% 58% Time ( Days) LENGTH>20 Cm Primary patency 1 STENT 79% 2 STENT 64.7% 3 STENT 66.7%

23 OUR EXPERIENCE LENGTH < 10 cm--- Limb Salvage cm---- >20 cm LIMB SALVAGE <10 cm cm >20 cm 1 year 86.7% 93.3% 85.4% Time ( Days) 2 years 69.3% 88.1% 85.4%

24 CONCLUSIONS Long SFA lesions and CLI are challenging cases Endoluminal by-pass technique offers good results 250 mm graft to avoid the overlapping (ENDO-BY-PASS) Correct sizing is key / Avoid Oversizing Surveillance is critical The edge-focal stenosis is easier to treat

25 THE THREE YEARS OUTCOME OF ENDOLUMINAL BYPASS FOR