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Forward Visions of Peripheral Vascular Medicine ; BTK Endovascular Interventions

Forward Visions of Peripheral Vascular Medicine ; BTK Endovascular Interventions . George L. Adams, MD, MHS, FACC Clinical Associate Professor of Medicine, University of North Carolina Health Systems Director of Cardiovascular and Peripheral Vascular Research, Rex Hospital. Disclosures.

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Forward Visions of Peripheral Vascular Medicine ; BTK Endovascular Interventions

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  1. Forward Visions of Peripheral Vascular Medicine ; BTK Endovascular Interventions George L. Adams, MD, MHS, FACC Clinical Associate Professor of Medicine, University of North Carolina Health Systems Director of Cardiovascular and Peripheral Vascular Research, Rex Hospital

  2. Disclosures • Education/Research • Abbott • Cardiovascular Systems Inc. • Cook Medical • Consulting • Cardiovascular Systems Inc. • Cook Medical • Daichi Sankyo

  3. Amputation Epidemic • PAD is a circulatory problem affecting 8 –12 million people in the U.S. • Two million of these have Critical Limb Ischemia (CLI) • Approximately 180,000 Amputations occur in the U.S. annually

  4. Consequences of CLI Fisher, Critical Limb Ischemia. Futura Publishing Company. Armonk, NY: 1999; 19-25 Jaff, M. EVT. 2004;3:2

  5. Can We Change Behavior? Above the Knee Below the Knee

  6. Outflow Impacts Patency and Limb Salvage Limb Salvage is Better with Good Outflow 5 Years Post-Endovascular Intervention (N=361 limbs) (SVS Modification Runoff Score) Gallino, Circulation 1984;70;619-624 Davies, M. JVS. 2008; 48:3; 619-626.

  7. Outflow Improves Survival Rates Survival is Better with Good Outflow 5 Years Post-Endovascular Intervention (SVS Modified Runoff Criteria) Davies, M. JVS. 2008; 48:3; 619-626.

  8. Angiosomes of the Body Angiosome Concept: Introduced by Taylor and Palmer in 1987 which divides the body into 3- dimensional vascular territories supplied by specific source arteries and drained by specific veins. Taylor I, PRS 89:181, 1991

  9. Angiosomes of Source Arteries (Lower leg) • Anterior Tibial Artery (anterior/lateral) • Posterior Tibial Artery (medial) • Peroneal Artery (posterior) Taylor I, PRS 89(2):181-215,1992

  10. Angiosomes of Source Arteries (Foot) Iida O, et al. EVT. Sept 2010; 96-100.

  11. Balloon Silverhawk Stent Laser Diamondback 360 Percutaneous Procedures Exotic Access

  12. Ulcer on the Medial Aspect of the Left Ankle Which Artery is Affected? Adams, GL 2011

  13. Ulcer on the Medial Aspect of the Left Ankle Endovascular Intervention Angiogram Adams, GL 2011

  14. Ulcer on the Medial Aspect of the Left Ankle – Post Intervention Adams, GL 2011

  15. Ulcers on the Lateral Aspect of the Right Lower Leg and Dorsum of the Foot Which Artery is Affected? Adams, GL 2011

  16. Ulcers on the Lateral Aspect of the Right Lower Leg and Dorsum of the Foot Intervention Angiogram Adams, GL 2011

  17. Ulcers on the Lateral Aspect of the Right Lower Leg and Dorsum of the Foot Post-Intervention Adams, GL 2011

  18. Case Study • 62 y/o female • Non-healing ulcer on right great toe • Scheduled for amputation Which artery below the knee is the most likely culprit?

  19. Lower Leg Intervention Initial Angios Pre Treatment Post Atherectomy/ PTA

  20. Post Intervention Post Atherectomyand PTA of Both Vessels and Runoff to Foot

  21. WHICH WOULD YOU RATHER? Percutaneous Surgical

  22. OR…

  23. Thank you!

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