dr. Sahal Fatah, SpB, SpBTKV

Objectives Arterial Vascular Disease

1. Peripheral Artery Disease 2. Thoracic Aortic Aneurysms3. Abdominal Aortic Aneurysms4. Lower and Upper Extremity Revascularization5. Lower and Upper Extremity Amputation

Objectives Venous Vascular Disease

1. Deep Vein Thrombosis 2. Superficial Vein Thrombosis 3. Varicose Veins4. Varicose Ulcers 5. Venous Gangrene

Operative Management Endovascular Surgery

Percutaneous Transluminal Angioplasty/Stenting (PTA)

Femoropopliteal Percutaneous Endovascular Intervention

Minimally Invasive (VATS)Lumbal or Thoracal Symphatectomy

Open Surgical TherapyFemoropopliteal Bypass (SVG, Dakron, ePTFE)Thromboembolectomy and EndarterectomyAmputation

Evolution of EndovascularDiagnostics and

Therapeutics

Era of Diagnostics(1929–1959)

The surgeon Renaldo Dos Santos, breakthrough applied to the extremities and to develop arteriography and aortography

Forssmann should be possible to insert a catheter into the right side of the heart through a venous channel and thereby:monitor cardiac pressuresobtain blood for analysis, andadminister therapeutic agents

Renaldo Dos Santos, MD,Pioneer surgeon and original

developer of diagnostic arterial visualization techniques and

technologies

Werner Forssmann, MD,Physician credited with developing

endovascular diagnostics by demonstrating cardiac assessment

using catheter

Sven Ivar SeldingerA radiologist from Sweden. He

introduced technique to obtain safe access to blood vessels and other

hollow organs

André Frédéric CournandA physiology from Columbia University of Physicians and

Surgeons who is known for cardio catheterization

Era of Therapeutics(1960–1990)

Embolectomy—Fogarty The earliest disease entity to be approached intraluminally was embolic occlusion.

Balloon Angioplasty—Dotter/Grüntzig used a balloon catheter made by Fogarty to expansion of the balloon caused an increase in the lumen diameter (iliac stenosis).

Atherectomy—Simpson developed the idea of mechanically removing atheroma from vessels lumen (atherectomy).

Charles Theodore DotterThe Father of Intervention.

Described angioplasty in 1964

Dr. Thomas J. Fogarty An American surgeon inventor of the

embolectomy catheter for removing an embolus, or blood clot

Andreas Roland Grüntzig A German cardiologist who first developed successful balloon

angioplasty for expanding lumens of narrowed arteries

Julio PalmazDoctor of vascular radiology. He got the idea for his stent after listening

to a lecture by Gruentzig at a conference in New Orleans in 1978.

Juan C. Parodi, MD,Vascular surgeon and designer who advanced the clinical techniques and

applications for the transluminally placed endovascular endograft

John B. Simpson, MD, Cardiologist and innovator

of catheter-mediated techniques for treating coronary artery

atherosclerosis

Lower Extremity RevascularizationAnatomy

Femoropopliteal percutaneous endovascular intervention

3. Femoropopliteal or Pop-DP, etc. bypass

Cross Over Graft

Deep Vein Thrombectomy

Before and After Thoracoscopy Symphatectomy

(Reynoud’s Disease)

Aortic Vascular Disease1. Aortic Aneurysm (Thoracalis, Abdominalis) 2. Aortic Dessection

Procedure : Endovascular (TEVAR, EVAR) Repair Aneurysm (AAA)

TEVAR

TEVAR

AAA

EVAR

OPEN REPAIR AAA