catheter based intervention and surgical management of peripheral arterial occlusive disease: ...
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CATHETER BASED INTERVENTION AND SURGICAL MANAGEMENT OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE: TECHNIQUE AND RESULTSDr Omar P. Haqqani, MD
Chief, Vascular and Endovascular SurgeryAssociate Professor of Surgery, Central Michigan University
DISCLOSURE
Author does not have any disclosures
IMPACT OF PAD ON MARTALITY
Lifestyle modification•Smoking cessation•Regular exercise training•Diet
Pharmacological treatment•Antiplatelet therapy•Control risk factors (e.g. hypertension, blood glucose)•Vasodilators for symptomatic relief
MANAGEMENT OF PAD PATIENTS
• Lifestyle limiting claudication• Rest Pain• Non-healing wounds
INDICATION FOR INTERVENTION
Endovascular•Revascularization (Angioplasty)•Stent Placement•Atherectomy (Directional or Laser)•Intravascular Ultrasound (IVUS)
Surgical•Endarterectomy•Peripheral Bypass Graft•Amputation
INDICATION FOR INTERVENTION
Endovascular•Revascularization (Angioplasty)•Stent Placement•Atherectomy (Directional or Laser)•Intravascular Ultrasound (IVUS)
Surgical•Endarterectomy•Peripheral Bypass Graft•Amputation
INDICATION FOR INTERVENTION
Plain Balloon•modifies obstructions through a disruptive stretching process
Drug-coated Balloon (DCB)•modifies obstructions through a disruptive stretching process with high-concentration, rapid local release of an antirestenotic drug
PLAIN BALLOON ANGIOPLASTY
DRUG COATED BALLOON (DCB) ANGIOPLASTY
Endovascular•Revascularization (Angioplasty)•Stent Placement•Atherectomy (Directional or Laser)•Intravascular Ultrasound (IVUS)
Surgical•Endarterectomy•Peripheral Bypass Graft•Amputation
INDICATION FOR INTERVENTION
Bare Metal Stent•modifies obstructions using a metallic scaffolding
Drug-eluting Stent (DES)•modifies obstructions using a metallic scaffolding with a slowly releasing drug to block cell proliferation
BARE METAL STENT PLACEMENT
DRUG ELUTING STENT (DES) PLACEMENT
Endovascular•Revascularization (Angioplasty)•Stent Placement•Atherectomy (Directional or Laser)•Intravascular Ultrasound (IVUS)
Surgical•Endarterectomy•Peripheral Bypass Graft•Amputation
INDICATION FOR INTERVENTION
LASER Atherectomy•Pulverizes obstructions using ultraviolet pulsed light
Directional Atherectomy•Excises obstructions using mechanical cutting devices
EXCIMER LASER ATHERECTOMY
DIRECTIONAL ATHERECTOMY
Endovascular•Revascularization (Angioplasty)•Stent Placement•Atherectomy (Directional or Laser)•Intravascular Ultrasound (IVUS)
Surgical•Endarterectomy•Peripheral Bypass Graft•Amputation
INDICATION FOR INTERVENTION
Intravascular Ultrasound (IVUS)•Intra-vessel ultrasonography to delineate composition and extent of obstructions
INTRAVASCULAR ULTRASOUND (IVUS)
RESULTS OF ARTERIAL RECONSTRUCTION
RESULTS OF ARTERIAL RECONSTRUCTION
RESULTS OF ARTERIAL RECONSTRUCTION
RESULTS OF ABOVE-KNEE INTERVENTION
POBA
DCB DES DAth LASER
BMS
RESULTS OF BELOW-KNEE INTERVENTION
POBA DCB
Endovascular•Revascularization (Angioplasty)•Stent Placement•Atherectomy (Directional or Laser)•Intravascular Ultrasound (IVUS)
Surgical•Endarterectomy•Peripheral Bypass Graft•Amputation
INDICATION FOR INTERVENTION
RESULTS OF ARTERIAL RECONSTRUCTION
RESULTS OF ABOVE-KNEE BYPASS
RESULTS OF BELOW-KNEE BYPASS
37 YO DM WITH ESRD
WET GANGRENE
37 YO DM WITH ESRD
37 YO DM WITH ESRD
ENDO VS OPEN OUTCOMES
BASIL (Bypass versus angioplasty in severe ischemia of the leg)– Angioplasty is recommended only for high risk patients with a projected survival of less than 2 years
Among patients undergoing repeat interventions 1 year patency 22 %
BENEFITS OF AN ENDO-FIRST APPROACH
• Remarkably safe even in high-risk patients
• Emergency operative bailout a rare event
• Endovascular re-intervention as successful as initial intervention
• Repeat interventions allows limb salvage to be prolonged in some cases indefinitely
• Preservation of distal targets
THANK YOU
Thank You