Catheter Based Intervention and Surgical Management of Peripheral Arterial Occlusive Disease: Technique and Results
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Dr. Omar P. Haqqani, MD discusses the details of catheter based blood vessel intervention, focussed on management of peripheral arterial disease (PAD).
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Catheter Based Intervention and Surgical Management of Peripheral Arterial Occlusive Disease: Technique and Results
- 1. CATHETER BASED INTERVENTION AND SURGICAL MANAGEMENT OF PERIPHERAL ARTERIAL OCCLUSIVE DISEASE: TECHNIQUE AND RESULTS Dr Omar P. Haqqani, MD Chief, Vascular and Endovascular Surgery Associate Professor of Surgery, Central Michigan University
- 2. DISCLOSURE Author does not have any disclosures
- 3. IMPACT OF PAD ON MARTALITY
- 4. 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
- 5. • Lifestyle limiting claudication • Rest Pain • Non-healing wounds INDICATION FOR INTERVENTION
- 6. Endovascular •Revascularization (Angioplasty) •Stent Placement •Atherectomy (Directional or Laser) •Intravascular Ultrasound (IVUS) Surgical •Endarterectomy •Peripheral Bypass Graft •Amputation INDICATION FOR INTERVENTION
- 7. 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
- 9. DRUG COATED BALLOON (DCB) ANGIOPLASTY
- 10. 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
- 11. BARE METAL STENT PLACEMENT
- 12. DRUG ELUTING STENT (DES) PLACEMENT
- 13. 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
- 16. 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
- 18. RESULTS OF ARTERIAL RECONSTRUCTION
- 19. RESULTS OF ARTERIAL RECONSTRUCTION
- 20. RESULTS OF ARTERIAL RECONSTRUCTION
- 21. RESULTS OF ABOVE-KNEE INTERVENTION POB A DCB DES DAth LASE R BMS
- 22. RESULTS OF BELOW-KNEE INTERVENTION POB A DCB
- 23. Endovascular •Revascularization (Angioplasty) •Stent Placement •Atherectomy (Directional or Laser) •Intravascular Ultrasound (IVUS) Surgical •Endarterectomy •Peripheral Bypass Graft •Amputation INDICATION FOR INTERVENTION
- 24. RESULTS OF ARTERIAL RECONSTRUCTION
- 25. RESULTS OF ABOVE-KNEE BYPASS
- 26. RESULTS OF BELOW-KNEE BYPASS
- 27. 37 YO DM WITH ESRD
- 28. WET GANGRENE
- 29. 37 YO DM WITH ESRD
- 30. 37 YO DM WITH ESRD
- 31. 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 %
- 32. 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