CRT: Primer for Endovascular Interventions

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Presentation transcript:

CRT: Primer for Endovascular Interventions Surgical Options for Femoralpoplital Arterial Disease CRT: Primer for Endovascular Interventions Jeffrey Wang MD, Horizon Vascular Specialists

Jeffrey Y. Wang, MD Consulting Fees: Medrad, Inc. Cordis Corporation

Tasc II Definitions

Native Vein Recommended conduit is GSV Patentcy Rates are 85-66% in the AK position Patency Rates are 67-42% in the BK position

Native Vein Advantages Disadvantages Excellent patency Resistant to infection Easier to sew Less expensive Disadvantages May not be available Can kink in the tunnel More extensive dissection Longer Procedure Inconsistent along the length

PTFE In the AK position results are almost as good as vein Patency in the AK position 75-47% Patency in the BK position 52-39% Courtesy of WL gore

PTFE Advantages Disadvantages Reasonable Patency Off the shelf availability Resistant to kinking Unlikely to degrade Uniform Disadvantages Less resistant to infection Size mismatch in smaller vessels

Dacron More commonly used in aortoiliac interventions Less popular in US. Patency rates similar to other prosthetics

Dacron Advantages Disadvantages Slightly easier to handle Durable Available Uniform Disadvantages Not resistant to infection More challenging to perform secondary interventions

Cryovein Cryopreserved cadaveric vein Patency 32-23.6% 1-3 yrs

Cryovein Advantages Disadvantages Resistant to infection Reasonable availability Easy to handle Disadvantages Must be ordered in advance Tendency to degrade Patency not improved

Common Femoral Common femoral endarterectomy > 85% patency 5yrs Use caution when intervening near the SFA and profunda origin Stenting in this area highly not recommended

AK Popliteal Above knee popliteal has about 6-10cm of accessible length Intervention needs to end prior to hunters canal to preserve above knee surgical option Medial Side of femur in AP projection Patency Rates 85-66% in the AK position vs. 67-42% in the BK position

Below knee pop Intervention should end 3 cm above take off of the AT Stenting is also not recommended in this area Bypass patency drops from 67-42% as low as 23% converting from bk pop to tibial bypass

Knee Joint Depends on the extent of the lesion Mechanical bend starts at the tibial plateau Stenting should be used very selectively

Conclusion Be aware of the constraints of both endovascular and surgical techniques Remember that treatment of PAD is palliative not curative There will always be a need to set up for the future