Biondi-Zoccai: Peripheral interventions [email protected] – metcardio.org Basic principles...
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Biondi-Zoccai: Peripheral interventions [email protected] – metcardio.org Basic principles of Basic principles of peripheral peripheral interventions interventions Giuseppe Biondi Zoccai Giuseppe Biondi Zoccai University of Turin, Turin, Italy University of Turin, Turin, Italy [email protected] [email protected] Educational Fellowship Course In PCI For Young Educational Fellowship Course In PCI For Young Interventionalists Interventionalists Session 2 - How do I treat: Case based Session 2 - How do I treat: Case based discussion discussion 22 October 2009 – 16:35-16:47 22 October 2009 – 16:35-16:47
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Transcript of Biondi-Zoccai: Peripheral interventions [email protected] – metcardio.org Basic principles...
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Basic principles of Basic principles of peripheral peripheral
interventionsinterventions
Giuseppe Biondi ZoccaiGiuseppe Biondi ZoccaiUniversity of Turin, Turin, ItalyUniversity of Turin, Turin, Italy
[email protected]@gmail.com
Educational Fellowship Course In PCI For Young Educational Fellowship Course In PCI For Young InterventionalistsInterventionalists
Session 2 - How do I treat: Case based discussionSession 2 - How do I treat: Case based discussion
22 October 2009 – 16:35-16:4722 October 2009 – 16:35-16:47
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rgDISCLOSUREDISCLOSURE
I am giving a lecture at a Fellows’ Course
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rgLEARNING GOALSLEARNING GOALS
Why peripheral interventions are important for everybody
General approachWhat is similar and what is different between coronary and peripheral arteries
District-specific tips & tricks
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rgLEARNING GOALSLEARNING GOALS
Why peripheral interventions are important for everybody
General approachWhat is similar and what is different between coronary and peripheral arteries
District-specific tips & tricks
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rgWHY SO IMPORTANT?WHY SO IMPORTANT?
PAD is often present in patients with established CAD
PAD may be the first and/or only manifestation of atherothrombosis in several pts
Peripheral complications during PCI or other cardiac interventions are not rare and should best be managed by YOU in the cath lab
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rgLEARNING GOALSLEARNING GOALS
Why peripheral interventions are important for everybody
General approachWhat is similar and what is different between coronary and peripheral arteries
District-specific tips & tricks
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A GLOBAL MANAGEMENT A GLOBAL MANAGEMENT APPROACH IS A MUSTAPPROACH IS A MUST
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rgTAKE CARE AT PREPPING TAKE CARE AT PREPPING
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ALWAYS BEGIN YOUR ALWAYS BEGIN YOUR TRAINING AND YOUR SINGLE TRAINING AND YOUR SINGLE PROCEDURE WITH A GOOD PROCEDURE WITH A GOOD QUALITY ANGIOQUALITY ANGIO
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IMAGING WITH DSA IS A IMAGING WITH DSA IS A MUST FOR ALL VESSELS < MUST FOR ALL VESSELS <
5.0 MM5.0 MM
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rgMINIMIZE RADIATION RISKMINIMIZE RADIATION RISK
2 MONTHS AFTER
PROCEDURE
6 MONTHS AFTER
PROCEDURE
2 YEARSAFTER
PROCEDURE
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rgLEARNING GOALSLEARNING GOALS
Why peripheral interventions are important for everybody
General approachWhat is similar and what is different between coronary and peripheral arteries
District-specific tips & tricks
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Garcia et al, Catheter Cardiovasc Interv 2009;74:27-36
COMMON ACCESS SITES FOR COMMON ACCESS SITES FOR PERIPHERAL=FOR PERIPHERAL=FOR
CORONARYCORONARY
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Garcia et al, Catheter Cardiovasc Interv 2009;74:27-36
LESS COMMON ACCESS SITES LESS COMMON ACCESS SITES FOR PERIPHERAL≠FOR FOR PERIPHERAL≠FOR
CORONARYCORONARY
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DEVICE TYPES ARE ALSO DEVICE TYPES ARE ALSO BROADLY SIMILARBROADLY SIMILAR
SheathsShuttle sheathsGuidewiresBalloonsStentsFiltersThrombectomy catheters
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BUT DEVICE SIZES AND BUT DEVICE SIZES AND FEATURES ARE VERY FEATURES ARE VERY
DIFFERENT!DIFFERENT!Sheaths (3-9 Fr)
Shuttle sheaths (30-90 cm)
Guidewires (0.014”, 0.018”, 0.035”)
Balloons (1.25-15.0 mm)
Stents (balloon-, self-expandable)
FiltersThrombectomy catheters (4-6
Fr)
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2.0-4.0
5.0-7.0
4.0-7.0
4.0-6.0
6.0-9.0
5.0-9.0
5.0-7.0
7.0-10.0
6.0-8.0
2.0-4.0
5.0-7.0
3.0-5.0
SIZE SIZE MATTERMATTER
S!S!
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rgLEARNING GOALSLEARNING GOALS
Why peripheral interventions are important for everybody
General approachWhat is similar and what is different between coronary and peripheral arteries
District-specific tips & tricks
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RENAL ARTERY STENOSISRENAL ARTERY STENOSIS
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RENAL ARTERY STENOSISRENAL ARTERY STENOSIS
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LOWER-LIMB LOWER-LIMB INTERVENTIONS:INTERVENTIONS:
TASC II 2007 vs. TASC 2000TASC II 2007 vs. TASC 2000
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IMPORTANCE OF SUBINTIMAL IMPORTANCE OF SUBINTIMAL ANGIOPLASTY FOR LOWER-LIMB ANGIOPLASTY FOR LOWER-LIMB
PTAPTA
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BTK PTA: TOOLS OF THE BTK PTA: TOOLS OF THE TRADETRADE
Biondi-Zoccai et al, J Endovasc Ther 2009
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ENDOVASCULAR ENDOVASCULAR ANEURYSM REPAIRANEURYSM REPAIR
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CAROTID ARTERY CAROTID ARTERY STENOSISSTENOSIS
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CAROTID ARTERY CAROTID ARTERY STENOSISSTENOSIS
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CAROTID ARTERY CAROTID ARTERY STENOSISSTENOSIS
McDonald et al, Stroke 2009
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McDonald et al, Stroke 2009
What about stroke?
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TAKE HOME MESSAGESTAKE HOME MESSAGES
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Peripheral intervention skills must be mastered by all interventional cardiologists for bail-out indications
Motivated interventionists can pursue further improvements by focusing on district-specific indications, anatomy, and devices
No other specialist beats an experienced cardiologists in peripheral interventions
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rgThank you for your attentionThank you for your attention
For any correspondence: For any correspondence: [email protected]
For these and further slides on these topics feel For these and further slides on these topics feel free to visit the metcardio.org website: free to visit the metcardio.org website:http://www.metcardio.org/slides.html
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rgABSTRACTABSTRACT
Cardiovascular specialists care for patients with cardiovascular disease which is often extensive and not localized in a single anatomic district. Thus, even interventional cardiologists should have a working knowledge of the indications, contraindications, general principles and specific techniques required for safe and succcessful peripheral interventions. Notwithstanding the need to overcome the limitations of angiographic luminology, a thorough knowledge of a single patient vascular anatomy, proficiency in obtaining vascular access, and availability of dedicated devices, paying attention in particular to device size and shaft length, are pivotal. This presentation offers a brief but comprehensive viewpoint on the basic principles that should be followed by interventional cardiologists willing to begin a peripheral intervention program.
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MULTIPLE CHOICE MULTIPLE CHOICE QUESTIONSQUESTIONS
Question 1- Which of the following accesses is inappropriate for the corresponding target vessel:a) right axillary artery for right carotid stenting;b) antegrade left femoral artery for left posterior tibial angioplasty;c) left radial artery for left renal stenting;d) retrograde right femoral access for left common iliac stenting; e) antegrade right femoral access for right superficial femoral angioplasty.
Question 2 - Which of the following peripheral interventional procedures would you consider not clinically indicated:a) right carotid stenting in a symptomatic patient with a 60% stenosis of the right internal carotid artery;b) left popliteal artery angioplasty in a patient with severe claudication and 75% stenosis of the left popliteal artery;c) left renal artery stenting in a non-hypertensive patient with 95% stenosis of the left renal artery;d) endovascular aneurysm repair in an asymptomatic patient with a 60-mm abdominal aorta aneurysm;e) left posterior tibial angioplasty in a patient with a left heel ischemic ulcer and focal occlusion of the posterior tibial artery.
