Angiosome concept myth or truth? Does it make a real difference in real world cases?
|
|
|
- Theodore Walters
- 5 years ago
- Views:
Transcription
1 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
2 Disclosure Speaker name:... 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) X I do not have any potential conflict of interest
3 Different comorbidities in CLI but almost comparable amputation-free survival Key baseline characteristics OLIVE PRVENT III CIRCULASE BASIL CRITISH EVT BSX+Drug Drug EVT/BSX EVT BSX Age>80 yrs 26% 18% 18% 26% Male 65% 65% 79% 66% 63% 68% DM 71% 62% 51% 39% 48% 48% Hemodialysis 52% 10% 5% Tissue loss 88% 74% 69% 75% 78% 73% Isolated BTK lesions 41% One-year AFS 74% 74.0% % 75% 72% Despite heterogeneity characteristics, 1-year AFS reveals around 75%. But, it is clinically difficult to simply compare to each study. Circ Cardiovasc Interv. 2013;6: J Vasc Surg 2006;43: J Vasc Surg 2006;43: Lancet 2005;366: J Vasc Surg. 2015;62:
4 Angiosome concept is important? Despite an aggressive approach for revascularization, amputation rates of up to 20% can occur despite a patent bypass in patients with CLI and tissue loss. Ischemic ulcer Revascularization Major amputation This has led to the proposal of an angiosome-based revascularization strategy (where the specific artery perfusing the corresponding diseased territory is revascularized). Sumpio BE et al. J Vasc Surg 2013;58:
5 74 years, Male, tissue loss at heel (R6) DM, ESRD on HD Severe stenosis presnted at ATA to DPA Poor flow to the calcaneal region was observed. (from DPA-pedal arch)
6 74 years, Male, tissue loss at heel (R6) DM, ESRD on HD Angioplasty for ATA-DPA Poor flow to calcaneal region despite ATA-DPA revascularization (1-straight line)
7 74 years, Male, tissue loss at heel (R6) DM, ESRD on HD Angioplasty for ATA-DPA 1-straight line Major amputation (BK amputaion)
8 Angiosomes of the lower extremity Angiosome is an anatomical concept, defined as the blood supply from a main, secondary or distributing artery to a specific tissue area. Shishehbor MH, et al. Circ Cardiovasc Interv. 2014;7:
9 Biancari F. Eur J Vasc Endovasc Surg. 2014;47: Meta-analysis of angiosome concept Forest plot for effectiveness in wound healing Forest plot for effectiveness in limb salvage
10 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity PAD: Executive Summary
11 2017 ESC Guidelines on the Diagnosis and Treatment of PAD, in collaboration with the ESVS 1) The decision of revascularization should also consider the angiosome concept, targeting the ischaemic tissues. 2) The angiosome model should not be used as an absolute strategy for interventions on patients with CLTI. 3) Further, well-structured prospective studies are needed to assess the value of the angiosome concept.
12 Why angiosome is clinically important? -1) Know limitations of BTK angioplasty- Repeat 1 year 3 months 40% 70% Iida O, et al. Eur J Vasc Endovasc Surg. 2012;44: Early 15 min. 97% Baumann F, et al. J Endovasc Ther. 2014;21: We should consider endovascular revascularization as absolute strategy providing blood flow efficiently because of presence of limitations of BTK angioplasty.
13 Why angiosome is clinically important? -2) Impact of angiosome differs from studies - Publication Country Limbs (Pts) Outcomes DM ESRD Alexandrescu, 2008 Retro 124 (98) Wound Healing 124 (100%) 27 (22%) Iida, 2010 Retro 203 (177) Limb Salvage 120 (68%) 96 (54%) Alexandrescu, 2011 Retro 232 (208) WH, LS, Mortality 232 (100%) 42 (18%) Blanes Orti, 2011 Retro 34 (32) Wound Healing 27 (73%) 13 (35%) Iida, 2012 Retro 369 (329) LS, Mortality 172 (73%) 149 (63%) Soderstrom, 2013 Retro 250 (226) Wound Healing 250 (100%) 39 (16%) Fossaceca, 2013 Retro 201 (201) WH, LS 201 (100%) 15 (7.4%) Acin, 2014 Retro 101 (92) WH, LS, Mortality 101 (100%) 0 (0%) More effective, Less effective Angiosome-guided angioplasty is more or less effective depending on the patient characteristics. Bunte MC, et al. Interv Cardiol Clin. 2017;6:
14 Association of cardiovascular risk factors with pattern of lower limb atherosclerosis Diehm N et al. Eur J Vasc Endovasc Surg. 2006:31;59 63.
15 Renal insufficiency is independently associated with a distal distribution pattern Diffuse severe calcification: (A) along the SFA; (B) occlusion of the distal ATA and proximal PA and complete occlusion of the PTA; and (C) occlusion of the plantar and dorsal arterial arches at the foot level. Wasmuth S et al. Eur J Vasc Endovasc Surg. 2010;39:
16 Diseased A-A (Artery-Artery) connection attributable to presence of DM and dialysis A-A connection from PA (peroneal artery) 1. Communicating branch to PTA 2. Calcaneal branch to PTA 3. Perforating branch to ATA Pedal arch ATA PTA
17 Discrepancy from theory to practice We should seek determinants of patients with CLI who derive the most clinical benefit from direct revascularization (DR). Indirect revascularization Limb salvage In clinical practice, moderate limb salvage rates (68-76%) were obtained by indirect revascularization (IR) in earlier studies. However, it remains unclear which patients derive the most clinical benefit from direct revascularization (DR).
18 Worse limb prognosis for IR vs. DR only in patients with CLI complicated with wound infection and DM (N=718) CLI complicated with both wound infection and DM, when IR has a poorer outcome. Indirect EVT & CRP 3 mg/dl DM n Hazard ratio for MALE (Ref) [0.67, 1.15] [0.54, 2.04] [1.54, 3.06]** Iida O, et al. Eur J Vasc Endovasc Surg. 2013;46:
19 CC: rt dorsalis gangrene Rutherford 6, W3I3FI2 * Severe wound infection PMH: HTN, DM, Aortic valve stenosis (AS) ADL: Ambulatory Skin perfusion pressure Dorsal 17mmHg Plantar 30mmHg Case: 97 yrs, female
20 Isolated Below-the-knee Lesion
21 US-guided Puncture for DPA System Guiding Sheath: Parent Plus 4.5Fr, 55cm Guide Wire: Cruise 0.014, 235cm Gladius 0.014, 200cm Back-up Catheter: Prominent 1.8/2.6Fr, 110cm Corsair PV 2.6Fr, 135cm EVT Balloon: Coyote MR 2.0*220mm Ultraverse 3.0*300mm
22 Bidirectional Wiring for ATA System Guiding Sheath: Parent Plus 4.5Fr, 55cm Guide Wire: Cruise 0.014, 235cm Gladius 0.014, 200cm Back-up Catheter: Prominent 1.8/2.6Fr, 110cm Corsair PV 2.6Fr, 135cm EVT Balloon: Coyote MR 2.0*220mm Ultraverse 3.0*300mm
23 Rendezvous Technique System Guiding Sheath: Parent Plus 4.5Fr, 55cm Guide Wire: Cruise 0.014, 235cm Gladius 0.014, 200cm Back-up Catheter: Prominent 1.8/2.6Fr, 110cm Corsair PV 2.6Fr, 135cm EVT Balloon: Coyote MR 2.0*220mm Ultraverse 3.0*300mm
24 Balloon Angioplasty for BTA System Guiding Sheath: Parent Plus 4.5Fr, 55cm Guide Wire: Cruise 0.014, 235cm Gladius 0.014, 200cm Back-up Catheter: Prominent 1.8/2.6Fr, 110cm Corsair PV 2.6Fr, 135cm EVT Balloon: Coyote MR 2.0*220mm Ultraverse 3.0*300mm
25 Final Angiography BTK BTA
26 After revascularization
27 The angiosome-oriented revascularization for CLI patients without concurrent wound infection and DM AFS Freedom from MALE There was no significant difference in terms of AFS and freedom from MALE for patients without concurrent wound infection and DM. Iida O, et al. J Endovasc Ther. 2014;21:
28 The angiosome-oriented revascularization for CLI patients without concurrent wound infection and DM Propensity matching Iida O, et al. J Endovasc Ther. 2014;21:
29 Angiosome Targeted PTA is More Important in patients with diabetes Direct PTA Direct PTA Indirect PTA with collaterals Indirect PTA with collaterals Indirect PTA Indirect PTA with no collaterals with no collaterals p = p In diabetic patients, indirect endovascular revascularization leads to the poorest wound healing and leg salvage rates. Endovascular procedures should be targeted according to the angiosome concept. Špillerová K, et al. Eur J Vasc Endovasc Surg. 2017;53:
![CC: rt 1 st digit gangrene Rutherford 5, W1I2FI0] *wound](/docs-images/89/100162091/images/30-1.jpg "infection (-) PMH: HTN, ESRD in dialysis Cerebral")
30 CC: rt 1 st digit gangrene Rutherford 5, W1I2FI0] *wound infection (-) PMH: HTN, ESRD in dialysis Cerebral infarction (CI) *Diabetes mellitus (-) ADL: wheel chair Skin perfusion pressure Dorsal 21mmHg Plantar 31mmHg Case: 83 yrs, female
31 Isolated Below-the-knee Lesion
32 Angioplasty for Dorsal System Guiding Sheath: Parent Plus 3Fr, 55cm Guide Wire: Cruise 0.014, 175cm Gladius 0.014, 235cm Back-up Catheter: Prominent 1.8/2.6Fr, 110cm EVT Balloon: JADE 2.5*120mm ULTRAVERSE 3.0*300mm
33 Final Angiography BTK BTA
34 Why angiosome is clinically important? -3) Aggressive wound care by angiosome Tx- Pre angioplasty POD 21 days Skin perfusion pressure Dorsalis pedis side 21mmHg 75mmHg Plantar side 31mmHg 39mmHg
35 Think about the Angiosome Concept Angiosome Concept DM With Infection Necessity Non-DM DM With Infection Without infection The angiosome concept always result in better wound healing Non-DM Without infection Less necessity Based on our analysis and experience, revascularization for woundrelated artery is best way to achieve better clinical outcomes.
36 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
3-year results of the OLIVE registry:
3-year results of the OLIVE registry: A prospective multicenter study in patients with critical limb ischemia Osamu Iida, MD Kansai Rosai Hospital Cardiovascular Center Amagasaki, Hyogo, Japan Disclosure
Olive registry: 3-years outcome of BTK intervention in Japan. Osamu Iida, MD Kansai Rosai Hospital Amagasaki, Hyogo, Japan
Olive registry: 3-years outcome of BTK intervention in Japan Osamu Iida, MD Kansai Rosai Hospital Amagasaki, Hyogo, Japan What is the optimal treatment for the patient with critical limb ischemia (CLI)?
The 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
Disclosures. 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
SPINACH Making Limb Salvage Salad from Spinach alone
SPINACH Making Limb Salvage Salad from Spinach alone Surgical reconstruction versus Peripheral Intervention in patients with critical limb ischemia prospective multicenter registry in Japan Nobuyoshi Azuma,
Current 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
PATIENT 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
Angiosome revascularization strategies in real world practice: how much difference does it make?
Angiosome revascularization strategies in real world practice: how much difference does it make? Peter A. Schneider, MD Kaiser Foundation Hospital Honolulu, Hawaii Disclosure Peter A. Schneider... I have
Interventional 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
THERE IS NO PROOF FOR THE ANGIOSOME CONCEPT
THERE IS NO PROOF FOR THE ANGIOSOME CONCEPT Peter Huppert Professor of Radiology and Neuroradiology Department of Radiology, Neuroradiology and Nuclear Medicine Klinikum Darmstadt Academic Teaching Hospital
Disclosures. 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
The present status of selfexpanding. for CLI: Why and when to use. Sean P Lyden MD Cleveland Clinic Cleveland, Ohio
The present status of selfexpanding and balloonexpandable tibial BMS and DES for CLI: Why and when to use Sean P Lyden MD Cleveland Clinic Cleveland, Ohio Disclosure Speaker name: Sean Lyden, MD I have
A transvenous intravascular ultrasound-guided technique for chronic total occlusion of a below-the-knee artery
A transvenous intravascular ultrasound-guided technique for chronic total occlusion of a below-the-knee artery Yasuhiro Takahashi 1, Reiko Shiomura 1, Erito Furuse 1 Junya Matsuda 1, Taisuke Sato 1, Wataru
Peripheral 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
Forget 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 -
Plantar arch and below-the-ankle angioplasty who, when and how?
Plantar arch and below-the-ankle angioplasty who, when and how? Presentation and case examples Tatsuya Nakama MD. Miyazaki Medical Association Hospital, Cardiovascular Center Miyazaki, Japan Disclosure
Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach
Successful endovascular treatment for BTK lesion using wire rendezvous technique and retrograde knuckle wire technique by collateral approach Katsutoshi Takayama, MD, Ph.D Department of Radiology and Interventional
GLOBAL 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
The results of EVT for Chronic Aortic Occlusion - a multicenter retrospective study - Taku Kato, MD Rakuwakai Otowa Hospital, Kyoto, Japan
The results of EVT for Chronic Aortic Occlusion - a multicenter retrospective study - Taku Kato, MD Rakuwakai Otowa Hospital, Kyoto, Japan COI disclosure Disclosure Speaker name: Taku Kato... I have the
John 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,
Global 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
Novel 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
Critical 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
Advanced d Techniques and Tools to Treat Below the Knee CTO
TCTAP 2013, Apr. 23-26, 2013, Seoul, Korea Cardiovascular Center Tokeidai Memorial Hospital Sapporo, Japan Crossing Strategy t for Complex & CTO Lesion - Cross with Confidence - Supported by Educational
The essentials for BTK procedures: wires, balloons, what else
A comprehensive approach to diabetic patient Tx The essentials for BTK procedures: wires, balloons, what else Dai-Do Do Clinical and Interventional Angiology Cardiovascular Department Disclosure Speaker
Diagnosis and Endovascular Treatment of Critical Limb Ischemia: What You Need to Know S. Jay Mathews, MD, MS, FACC
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,
Hiroshi Ando, MD Kasukabe Chuo General Hospital Saitama, Japan
Hiroshi Ando, MD Kasukabe Chuo General Hospital Saitama, Japan Disclosure Hiroshi Ando, MD Kasukabe Chuo General Hospital I have the following potential conflicts of interest to report: Consulting Employment
LIMB 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
Aggressive 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
Endovascular 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
Step 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
Hybrid 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
Objective 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
Distal 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
Current Status and Limitations in the Treatment of Femoropopliteal In-Stent Restenosis
Current Status and Limitations in the Treatment of Femoropopliteal In-Stent Restenosis Osamu Iida, MD From the Kansai Rosai Hospital Cardiovascular Center, Amagasaki City, Japan. ABSTRACT: Approximately
When 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,
Specificities for infrapopliteal stents
Specificities for infrapopliteal stents Nicolas Diehm, M.D. Swiss Cardiovascular Center Clinical and Interventional Angiology University Hospital Bern, Switzerland Disclosures Speaker`s Bureau: MEDRAD,
Dealing with Calcification in BTK Arteries: Is Lithoplasty the Answer?
Dealing with Calcification in BTK Arteries: Is Lithoplasty the Answer? Andrew Holden, MBChB, FRANZCR, EBIR Director of Interventional Radiology Auckland, New Zealand LINC 2017 January 25 th 2017 Disclosure
2D Perfusion imaging to assess the result of BTK interventions. Shinya Sasaki, M.D. Saka General Hospital Miyagi, JAPAN
2D Perfusion imaging to assess the result of BTK interventions Shinya Sasaki, M.D. Saka General Hospital Miyagi, JAPAN Disclosure Speaker name: Shinya Sasaki, MD.... I have the following potential conflicts
In foot treatment : what not to do? clinical experience. E.Ducasse MD PhD FEVBS Unit of vascular surgery CHU bordeaux
In foot treatment : what not to do? clinical experience E.Ducasse MD PhD FEVBS Unit of vascular surgery CHU bordeaux Disclosure Speaker name: Pr E Ducasse I do not have any potential conflict of interest
Will it heal? How to assess the probability of wound healing
Will it heal? How to assess the probability of wound healing Richard F. Neville, M.D. Professor of Surgery Chief, Division of Vascular Surgery George Washington University Limb center case 69 yr old male
Francisco Acín, César Varela, Ignacio López de Maturana, Joaquín de Haro, Silvia Bleda, and Javier Rodriguez-Padilla
International Journal of Vascular Medicine, Article ID 27539, 13 pages http://dx.doi.org/1.1155/214/27539 Clinical Study Results of Infrapopliteal Endovascular Procedures Performed in Diabetic Patients
The PIERCE technique for recanalization of heavily calcified arteries in hemodialysis patients.
The PIERCE technique for recanalization of heavily calcified arteries in hemodialysis patients. Tomoyasu Sato ( tomoyasu_satou@yahoo.co.jp ) Department of interventional and diagnostic Radiology Tsuchiya
DCB 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
One Year after In.Pact Deep: Lessons learned from a failed trial. Prof. Dr. Thomas Zeller
One Year after In.Pact Deep: Lessons learned from a failed trial Prof. Dr. Thomas Zeller Disclosure Speaker name: Thomas Zeller... I have the following potential conflicts of interest to report: x Consulting:
IMPORTANT INFORMATION: These materials are intended to describe common clinical considerations and procedural steps for the on-label use of
IMPORTANT INFORMATION: These materials are intended to describe common clinical considerations and procedural steps for the on-label use of referenced technologies as well as current standards of care
Clinical 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
Angiographic dissection pattern and patency outcomes of post balloon angioplasty for SFA lesions -a retrospective multi center analysis-
Angiographic dissection pattern and patency outcomes of post balloon angioplasty for SFA lesions -a retrospective multi center analysis- Masahiko Fujihara Kishiwada Tokushukai Hospital, Osaka, Japan Disclosure
Wifi classification does not predict limb amputation risk in dialysis patients following critical limb ischemia revascularization
Wifi classification does not predict limb amputation risk in dialysis patients following critical limb ischemia revascularization A Sonetto, M Abualhin, M Gargiulo, GL Faggioli, A Stella Disclosure Speaker
9/7/2018. 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
6/6/2016. 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
Update 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
ISR-treatment The Leipzig experience with purely mechanical debulking. Sven Bräunlich Department for Angiology University-Hospital Leipzig, Germany
ISR-treatment The Leipzig experience with purely mechanical debulking Sven Bräunlich Department for Angiology University-Hospital Leipzig, Germany Disclosure Speaker name: Sven Bräunlich I have the following
Drug-Eluting Balloon Angioplasty versus Bare Metal Stents for Femoropopliteal Disease in Real-World Experience
Drug-Eluting Balloon Angioplasty versus Bare Metal Stents for Femoropopliteal Disease in Real-World Experience Maria Doyle, M.Eng; Hilary Coffey, M.D. Ravindra Gullipalli, MBBS, FRCR St. Clare s Mercy
Perfusion 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,
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
Are DES and DEB worth the cost in BTK interventions?
Are DES and DEB worth the cost in BTK interventions? Thomas Zeller, MD University Heart-Center Freiburg-Bad Krozingen Bad Krozingen, Germany -1- My Disclosures: Advisory Board: Medtronic-Invatec, Gore,
Managing 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
Endovascular 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
Current 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
Making the difference with Live Image Guidance
Live Image Guidance 2D Perfusion Making the difference with Live Image Guidance In Peripheral Arterial Disease Real-time results, instant assessment Severe foot complications the result of hampered blood
The LIMBO trial: a RCT investigating adventitial dexamethasone infusion to prevent restenosis in BTK arteries utilizing a novel angiographic endpoint
The LIMBO trial: a RCT investigating adventitial dexamethasone infusion to prevent restenosis in BTK arteries utilizing a novel angiographic endpoint Dr. Ulrich Beschorner Universitäts Herzzentrum Freiburg
Comparison 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,
Maximizing Outcomes in a complex population with Drug-coated balloon
Maximizing Outcomes in a complex population with Drug-coated balloon March 13, 2018 Chumpol Wongwanit, MD Siriraj Hospital, Mahidol University, Bangkok, Thailand LINC Asia-Pacific 2018, Hong Kong Disclosure
Catheter-Directed Thrombolysis for Acute Limb Ischemia. Hwan Jun Jae MD Seoul National University Hospital Seoul, Korea
Catheter-Directed Thrombolysis for Acute Limb Ischemia Hwan Jun Jae MD Seoul National University Hospital Seoul, Korea Disclosure Speaker name: Hwan Jun Jae... I have the following potential conflicts
BIOLUX P-III Passeo-18 Lux All-comers Registry: 12-month Results for the All-Comers Cohort
BIOLUX P-III Passeo-18 Lux All-comers Registry: 12-month Results for the All-Comers Cohort Prof. Dr. Gunnar TEPE, Klinikum Rosenheim, Germany CCI on behalf of the BIOLUX P-III Investigators Disclosure
How do I use mechanical debulking for the treatment of arterial occlusions
How do I use mechanical debulking for the treatment of arterial occlusions Sven Bräunlich, MD Division of Interventional Angiology University-Hospital Leipzig, Germany Disclosure Speaker name: Sven Bräunlich
OMNIA case results: Lumee Oxygen measurements representative for CLI wound healing prognosis. M Werner 1 Feb 2018
OMNIA case results: Lumee Oxygen measurements representative for CLI wound healing prognosis M Werner 1 Feb 2018 Disclosure Speaker name:... I have the following potential conflicts of interest to report:
Surgery 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
Clinical Data Update for Drug Coated Balloons (DCB) Seung-Whan Lee, MD, PhD
Clinical Data Update for Drug Coated Balloons (DCB) Seung-Whan Lee, MD, PhD Asan Medical Center, Heart Institute, University of Ulsan College of Medicine, Werk et al. Circulation Cardiovasc Intervent 2012
Wound and surgery-guided revascularization & flow-guided surgery: the multidisciplinary approach to limb salvage
Wound and surgery-guided revascularization & flow-guided surgery: the multidisciplinary approach to limb salvage Vincenzo Foppa, 1462 The miracle of the salvaged foot Cappella Portinari, S. Eustorgio Church
2 Year Results from the MDT SFA Japan Trial - DCB vs. standard PTA for the treatment of atherosclerotic lesions in the SFA/PPA
2 Year Results from the MDT- 2113 SFA Japan Trial - DCB vs. standard PTA for the treatment of atherosclerotic lesions in the SFA/PPA Osamu Iida, MD - Kansai Rosai Hospital, Hyogo, Japan Hiroyoshi Yokoi,
Peripheal artery occlusive disease(from aorta to popliteal) 연세대학교의과대학 심장혈관병원최동훈
Peripheal artery occlusive disease(from aorta to popliteal) 연세대학교의과대학 심장혈관병원최동훈 Case 1 Aorta disease -antegrade via brachial artery, subintimal approach, wire retraction, kissing stent- M / 59 # 4268376
Case Discussion. Disclosures. Critical Limb Ischemia: A Selective Approach to Revascularization Works Best 4/28/2012. None. 58 yo M, DM, CAD, HTN
Critical Limb Ischemia: A Selective Approach to Revascularization Works Best None Disclosures Michael S. Conte MD, FACS Division of Vascular and Endovascular Surgery Co-Director, Heart and Vascular Center
Is 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
ASSESSING FOOT PERFUSION AFTER BTK REVASCULARIZATION
ASSESSING FOOT PERFUSION AFTER BTK REVASCULARIZATION Miguel Montero-Bakerr Associate Professor of Vascular Surgery Baylor College of Medicine Houston, TX, USA TRANSPORT BTK disease DISTRIBUTION BTA disease
Vascular screening in diabetic patients: how aggressive should we be and when to intervene?
Vascular screening in diabetic patients: how aggressive should we be and when to intervene? Roberto Ferraresi Peripheral Interventional Unit Bergamo Italy Disclosure Speaker name: ROBERTO FERRARESI X X
Lower Extremity Peripheral Arterial Disease: Its All About the Pulse. Spence M Taylor, M.D.
Lower Extremity Peripheral Arterial Disease: Its All About the Pulse Spence M Taylor, M.D. President, Greenville Health System Clinical University Senior Associate Dean for Academic Affairs and Diversity
The incidence of peripheral artery disease (PAD)
Pharmacologic Options for Treating Restenosis The role of cilostazol in the treatment of patients with infrainguinal lesions. By Osamu Iida, MD, and Yoshimitsu Soga, MD The incidence of peripheral artery
Clinical use and safety of the Lutonix DCB for the treatment of BTK: interim data from a prospective registry
Clinical use and safety of the Lutonix DCB for the treatment of BTK: interim data from a prospective registry Alexander Zimmermann Department of Vascular and Endovascular Surgery Klinikum rechts der Isar
Nurse and Technician Forum Part II Critical Limb Ischemia: Optimal care, an interdisciplinary challenge
L E I P Z I G I N T E R V E N T I O N A L C O U R S E 2017 Nurse and Technician Forum Part II Critical Limb Ischemia: Optimal care, an interdisciplinary challenge Markus Haumer Landesklinikum Baden-Mödling
Safety 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,
Imaging 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
Koen Keirse, MD RZ Tienen, Belgium
Clinical Benefits of the Vanguard IEP Peripheral Balloon Angioplasty System with Integrated Embolic Protection from the ENTRAP Study Koen Keirse, MD RZ Tienen, Belgium Disclosure Speaker name: Koen Keirse...
Disclosures. 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
Disclosures. In-Stent Restenosis: The Tail IS Wagging the Dog 4/15/2016. Restenosis: The Continuing Challenge for Peripheral Vascular Intervention
In-Stent Restenosis: The Tail IS Wagging the Dog Disclosures NONE Michael S. Conte MD Division of Vascular and Endovascular Surgery UCSF Heart and Vascular Center UCSF Vascular Symposium 2016 IF YOU WERE
The Crack and Pave technique for highly resistant calcified lesions. Manuela Matschuck MD University Hospital Leipzig Department Angiology
The Crack and Pave technique for highly resistant calcified lesions Manuela Matschuck MD University Hospital Leipzig Department Angiology Disclosure Speaker name: Dr. med. Manuela Matschuck I have the
Long-term Zilver PTX Data from Japan: 5-year Results in the Real World
Long-term Data from Japan: 5-year Results in the Real World Hiroyoshi Yokoi, MD Department of Cardiovascular Medicine Fukuoka Sanno Hospital Fukuoka, Japan On behalf of the Investigators Disclosure Speaker
Endovascular 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
Access 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
Advances in the treatment of posterior cerebral circulation symptomatic disease
Advances in the treatment of posterior cerebral circulation symptomatic disease Athanasios D. Giannoukas MD, MSc(Lond.), PhD(Lond.), FEBVS Professor of Vascular Surgery Faculty of Medicine, School of Health
CRITICAL LIMB ISCHEMIA UNITED STATES EPIDEMIOLOGY TABLE OF CONTENTS
CRITICAL LIMB ISCHEMIA UNITED STATES EPIDEMIOLOGY TABLE OF CONTENTS CRITICAL LIMB ISCHEMIA... 1 CONCLUSION... 9 U.S. CRITICAL LIMB ISCHEMIA PREVALENCE... 9 MARKET OPPORTUNITY ENDOVASCULAR... 9 MARKET OPPORTUNITY
Update from Korea on the Lutonix SFA registry 12 month data
Update from Korea on the Lutonix SFA registry 12 month data Prospective, Multicenter, Post-Market Registy Assessing the Clinical Use and Safety of the Lutonix Drug Coated Balloon in Femoropopliteal Arteries
Retrograde dorsalis pedis and posterior tibial artery access after failed antegrade angioplasty
Retrograde dorsalis pedis and posterior tibial artery access after failed antegrade angioplasty Poster No.: C-2067 Congress: ECR 2010 Type: Topic: Authors: Keywords: DOI: Scientific Exhibit Interventional
Limb 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
Maximally Invasive Vascular Surgery for the Treatment of Critical Limb Ischemia
Maximally Invasive Vascular Surgery for the Treatment of Critical Limb Ischemia Traci A. Kimball, MD Department of Surgery Grand Rounds Septemember 13, 2010 Overview Defining Critical Limb Ischemia Epidemiology
Endovascular Options in Critical Limb Ischemia: Below The Knee Therapies
Endovascular Options in Critical Limb Ischemia: Below The Knee Therapies Bret N. Wiechmann, MD FSIR FAHA FSVM Vascular & Interventional Physicians Gainesville, Florida Disclosures Consultant: Medcomp Bard
January 23, Vascular and oncological interventional radiology Paris Descartes University
January 23, 2019 First time data release: Paclitaxel-coated balloon in below-the-knee lesions: 6-months results from the Ranger BTK single center study Dr. Costantino Del Giudice Prof Marc Sapoval Vascular
PAD Characterization Within A Healthcare System" RAPID Face-to-Face Meeting Schuyler Jones, MD September 14, 2016
PAD Characterization Within A Healthcare System" RAPID Face-to-Face Meeting Schuyler, MD September 14, 2016 Interventional Cardiology and Cath Labs Disclosures Research Grants: Agency for Healthcare Research
Peripheral Arterial Disease: the growing role of endovascular management
Peripheral Arterial Disease: the growing role of endovascular management Poster No.: C-1931 Congress: ECR 2012 Type: Educational Exhibit Authors: E. M. C. Guedes Pinto, E. Rosado, D. Penha, P. Cabral,