Hybrid Procedures for Peripheral Obstructive Disease - Step by Step -
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1 Hybrid Procedures for Peripheral Obstructive Disease - Step by Step - Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery
2 Disclosure Speaker name:..holger Staab... 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 What patients and what lesions do we treat? Multilevel peripheral arterial occlusive disease involving the common femoral artery with Critical limb ischemia and high cardiovascular and pulmonary risc factors
4 Hybrid Techniques Minimal surgery + Angioplasty (inflow/outflow)
5 Hybrid Techniques + inflow angioplasty CFA endarterectomy + outflow angioplasty Femoral-femoral Bypass Femoro-popliteal Bypass
6 1. Clasical Hybrid case: Occlusion of CFA, 63 y/o male Pt. central PFA and SFA CLI on the right side (non-healing calf ulcer), PAD Rutherford 5 on the right side Multiple cardio-vascular risk factors COPD Gold III
7 1. Clasical Hybrid case: Occlusion of CFA, central PFA and SFA - dedicated endovascular suite - both groins sterile prepared
8 1. Clasical Hybrid case: Occlusion of CFA, central PFA and SFA - dedicated endovascular suite - both groins sterile prepared Endarteriectomy of right CFA PFA and short segment SFA closure with bovine patch
9 Angiography Occlusion of CFA and central PFA Occlusion of SFA
10 Angioplasty Cross-over access to the right SFA crossing the lesion with PT2 wire/ multipurpose catheter PTA of SFA and Implantation 6/60 Nitinol Stent
11 Final Result
12 2. CFA endarterectomy + Aorto-iliac angioplasty with bifurcated Endograft 82 y/o male Pt. CLI Rutherford 4 on the left side Multiple cardio-vascular risk factors Chronic Occlusion of left CIA,EIA,CFA
13 2. CFA endarterectomy + Aorto-iliac angioplasty with bifurcated Endograft Retrogade access through the Patch to the left EIA after TEA (0.035 Terumo Stiff wire/ multipurpose catheter) Post Balloon dilatation (Admiral 9/40mm) Endograft at the level of the renal arteries
14 2. CFA endarterectomy + Aorto-iliac angioplasty with bifurcated Endograft Kissing Stent of the aortic bifurcation Final Result
15 3. CFA endarterectomy + iliac angioplasty+ EVAR 56 y/o male Pt. PAOD Rutherford 3 on the left side AAA, Ø - 55 mm Multiple cardio-vascular risk factors Chronic Occlusion of left EIA,CFA
16 3. CFA endarterectomy + iliac angioplasty+evar Cross-over access to the left EIA(0.035 Terumo Stiff wire/ multipurpose catheter) after CFA-TEA and pre-dilation CFA post TEA Endograft at the level of the renal arteries
17 3. CFA endarterectomy + iliac angioplasty+evar Final Result
18 4. CFA endarterectomy + SFA Angioplasty 44 y/o male Pt. CLI on the right side (nonhealing calf ulcer) Multiple cardio-vascular risk factors Chronic Occlusion of right CFA and SFA
19 4. CFA endarterectomy + SFA Angioplasty Puncture of the patch in the CFA after CFA- TEA and antegrade access to the right SFA Final Result
20 Tips & Tricks for Hybrid Techniques Perform first the CFA-TEA and then the puncture Risk: - subintimal wire passage in the iliac artery after puncture of the occluded CFA Cross the iliac lesion in an antegrade fashion via a cross-over or a brachial puncture when you fail the retrograde access
21 Tips & Tricks for Hybrid Techniques Place stents in the distal external iliac artery only AFTER CFA endarterectomy and patchplasty Risk: - poor clamping for proximal bleeding control - thrombosis of the stented iliac artery
22 Hybrid Techniques Benefits: - Less invasive procedure - Overcome more complex anatomies in high-risk patients - High initial technical success (90% to 95% ) - No need for extensive venous graft material A M Schrijver et al. J Cardiovasc Surg 2010: 51; H H Dosluoglu et al. J Vasc Surg 2010:51;
23 Hybrid Techniques open revascularization endovascular techniques
24 Hybrid Procedures for Peripheral Obstructive Disease - Step by Step - Holger Staab, MD University Hospital Leipzig, Germany Clinic for Vascular Surgery
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