JORGE FERNÁNDEZ NOYA ANGIOLOGY AND VASCULAR SURGERY DEPARTMENT UNIVERSITARY CLINICAL HOSPITAL SANTIAGO DE COMPOSTELA THE THREE YEARS OUTCOME OF ENDOLUMINAL BYPASS FOR
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
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
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)
LITERATURE WORLD EXPERIENCE OUR EXPERIENCE
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
ENDOLUMINAL BY-PASS Planning with Duplex-Scan or CT.
ENDOLUMINAL BY-PASS Avoid Oversizing ( <20%) Effects of Device Sizing: Proximal 91% p<0.05 70% Effects of Device Sizing: Distal 87% 72% p=0.09 VIPER TRIAL
ENDOLUMINAL BY-PASS Angiogram: Looking for proximal and distal ( 1cm) healthy vessel
ENDOLUMINAL BY-PASS Don t cover genicular arteries
ENDOLUMINAL BY-PASS Post-dilatation inside the device.
OUR EXPERIENCE RetrospectIive June 2010-june 2013. 94 Patients ( 101 Limbs ) Average Follow up 383 days. 73.5 % male Average age: 72.5 years old.
OUR EXPERIENCE 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0
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
OUR EXPERIENCE CATEGORY 4: ISCHEMIC REST PAIN 28.5% CATEGORY 5: MINOR TISSUE LOSS 63.3% CATEGORY 6: MAJOR TISSUE LOSS 8.2%
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% 10-20 cm 32.7% >20 cm 52% Run off 0 5.1% 1 52% 84.7% 57.1% 2 31.6% 3 11.2%
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%
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%
OUR EXPERIENCE RUTHERFORD CATEGORY --- Rutherford 4 Primary Patency --- Rutherford 5 --- Rutherford 6 Limb Salvage Time ( Days) PRIMARY PATENCY 4 5 6 1 year 75.3% 83.2% 50% 2 years 75.3% 71.3% ----- Time ( Days) LIMB SALVAGE 4 5 6 1 year 94.7% 91.6% 37.5% 2 years 94.7% 85% -----
OUR EXPERIENCE LENGTH < 10 cm--- 10-20 cm---- PRIMARY PATENCY <10 cm 10-20 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%
OUR EXPERIENCE LENGTH < 10 cm--- Limb Salvage 10-20 cm---- >20 cm LIMB SALVAGE <10 cm 10-20 cm >20 cm 1 year 86.7% 93.3% 85.4% Time ( Days) 2 years 69.3% 88.1% 85.4%
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
THE THREE YEARS OUTCOME OF ENDOLUMINAL BYPASS FOR