Endovascular Live Case Mount Sinai Hospital, NY

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Presentation transcript:

Endovascular Live Case Mount Sinai Hospital, NY 08/23/2017

History and Examination 83 year old female Type 2 DM, HTN, dyslipidemia Severe bilateral lower extremity claudication (Rutherford category 3) (Right>Left) BP- 144/86 mmHg, Pulse- 62/min

Labs and non-invasive testing Hb- 10.5 Platelets – 301 k INR – 1.1 Creatinine – 0.76 ABI- 0.62(right), 0.88(left)

Inflow

Proximal cap

Distal reconstitution

Below knee run off

Foot angiogram

Strategy 7F left CFA access, 45 cm Pinnacle sheath Right distal SFA access, retrograde crossing Wire externalization Predilatation, Filter placement Atherectomy Drug coated balloon, Drug eluting stent

Clinical challenges TASC II type D, Tosaka-class 3 Unfavorable proximal cap Durability of definitive therapy

Femoropopliteal restenosis

Definitive therapy Drug coated balloon Drug eluting stent Laser Stent Graft Brachytherapy Surgical bypass

DEBATE-ISR, 36 months

Thank you

On going trials COPA CABANA ISRA PEBIS PHOTO PAC

Zilver PTX study slide

Vessel recoil, dissection No hardware Thrombotic risk (need for antiplatelet) Surgical risk DCB ?? DES LASER Stent Graft ++ --- Brachytherapy - + Surgical bypass