Peripheral Vascular Intervention (PVI) Dr. Daniel Bertges University of Vermont

1. Peripheral Vascular Intervention (PVI) Dr. Daniel Bertges University of Vermont

2. Agenda: I.    Overview of Inclusion/Exclusion Criteria II.   A & P Overview III.  Pertinent Device Overview IV.  Live abstraction

3. Inclusion/Exclusion Criteria: Inclusion: o Percutaneous and/or cut-down interventional catheter-based procedures of native leg arteries including balloon angioplasty, stenting/stent grafting, and/or atherectomy for arterial atherosclerotic occlusive disease of the infrarenal aorta or distal arteries and true aneurysms of the femoral, profunda or popliteal arteries. o Primary (first time) interventions and any and all secondary/subsequent interventions are included. Subsequent “redo” interventions on the same target vessel are included. Subsequent interventions are also included if on other vessels. o Hybrid peripheral vascular interventions done with concomitant femoral endarterectomy are included. Interventions on arteries proximal or distal to an existing leg bypass are included, but interventions to any part of a bypass including the anastomosis or graft are not captured. Isolated thrombolysis or mechanical clot extraction are not captured, unless lysis is done as an adjunct to primary treatment of an atherosclerotic lesion. o Note that attempted interventional procedures that were technically unsuccessful because the lesion could not be crossed should be entered.

4. Inclusion/Exclusion Criteria: Exclusions: o Treatment of vein or prosthetic grafts (this treatment is captured on the follow-up form for the original bypass) o Abdominal aortic and iliac aneurysms o Upper extremity, mesenteric or renal peripheral vascular interventions. (PVI is limited to Infra Renal peripheral vascular interventions.) o Diagnostic procedures not associated with interventions o Isolated Femoral endarterectomy (on the common femoral, superficial femoral and/or profunda) without simultaneous PVI are excluded. o Thrombolysis, percutaneous embolectomy or mechanical thrombectomy without angioplasty, stenting/stent grafting or atherectomy are excluded. If thrombolysis, percutaneous or mechanical embolectomy was done in preparation for a staged PVI then include the second (staged) procedure in the registry. o If a surgical incision is made to do an embolectomy (i.e. with Fogarty balloon catheter) on an artery being treated for occlusive disease then exclude the case. However, if the surgical incision and embolectomy are done for a complication of PVI then include the case and record in the postoperative tab (even if it’s done during the same operative session). o Treatment of an infected aneurysm, embolic occlusive disease, trauma or pseudoaneurysm o Patients undergoing treatment of a peripheral artery in order to gain access for PVI of an artery not captured in the registries (renal, mesenteric, innominate, subclavian etc) are excluded.

5. Anatomy: Normal aortogram : Infrarenal aorta Left common iliac artery Right internal iliac artery Left external iliac artery

6. Left common femoral artery Profunda femoral artery Left superficial femoral artery

7. Normal right leg arteriogram: knee level Lateral Popliteal artery above the knee Knee joint Popliteal artery below the knee Medial Unsubtracted image showing background bony landmarks Subtracted image

8. Normal right leg arteriogram: upper calf Lateral Tibial peroneal trunk Anterior tibial artery Medial Peroneal artery Posterior tibial artery Unsubtracted image showing background bony landmarks Subtracted image

9. Normal right leg arteriogram: lower calf level Lateral Posterior tibial artery Anterior tibial artery Medial Unsubtracted image showing background bony landmarks Subtracted image

10. Normal right leg arteriogram: foot Lateral Medial Posterior tibial artery at ankle Dorsalis pedis artery Plantar arteries

11. TASC Grade

12. TASC Grade

13. Pertinent Device Overview: • Self expanding stent

14. Pertinent Device Overview: • Balloon expandable stent

15. Pertinent Device Overview: • Stent grafts 1. Self expanding 2. Balloon expandable

16. Pertinent Device Overview: Atherectomy • Recorded as Treatment type = atherectomy • Manufacturer (many) • Type of device (multiple) • No longer have to classify as mechanical, laser etc…

17. Pertinent Device Overview: drug coated balloon

18. Pertinent Device Overview: drug coated balloon • Paclitaxel is in the taxane family of chemotherapeutic medications • works by interference with the normal function of microtubules during cell division • 3 FDA approved DCBs in US • Device identification critical to tracking efficacy and safety for our patients

19. Device: device class recorded

20. Case Abstraction: • https://pathways-demo.m2s.com • USER: VAM2019 • Password: #1registry • Patient Last Name: PVI

21. Questions