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
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DISCLOSURE
Author does not have any disclosures
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IMPACT OF PAD ON MARTALITY
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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
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• Lifestyle limiting claudication• Rest Pain• Non-healing wounds
INDICATION FOR INTERVENTION
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Endovascular•Revascularization (Angioplasty)•Stent Placement•Atherectomy (Directional or Laser)•Intravascular Ultrasound (IVUS)
Surgical•Endarterectomy•Peripheral Bypass Graft•Amputation
INDICATION FOR INTERVENTION
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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
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PLAIN BALLOON ANGIOPLASTY
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DRUG COATED BALLOON (DCB) ANGIOPLASTY
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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
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BARE METAL STENT PLACEMENT
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DRUG ELUTING STENT (DES) PLACEMENT
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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
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EXCIMER LASER ATHERECTOMY
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DIRECTIONAL ATHERECTOMY
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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
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INTRAVASCULAR ULTRASOUND (IVUS)
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RESULTS OF ARTERIAL RECONSTRUCTION
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RESULTS OF ARTERIAL RECONSTRUCTION
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RESULTS OF ARTERIAL RECONSTRUCTION
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RESULTS OF ABOVE-KNEE INTERVENTION
POBA
DCB DES DAth LASER
BMS
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RESULTS OF BELOW-KNEE INTERVENTION
POBA DCB
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Endovascular•Revascularization (Angioplasty)•Stent Placement•Atherectomy (Directional or Laser)•Intravascular Ultrasound (IVUS)
Surgical•Endarterectomy•Peripheral Bypass Graft•Amputation
INDICATION FOR INTERVENTION
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RESULTS OF ARTERIAL RECONSTRUCTION
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RESULTS OF ABOVE-KNEE BYPASS
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RESULTS OF BELOW-KNEE BYPASS
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37 YO DM WITH ESRD
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WET GANGRENE
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37 YO DM WITH ESRD
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37 YO DM WITH ESRD
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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 %
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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
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THANK YOU
Thank You