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

2. 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

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

4. Inflow

5. Proximal cap

6. Distal reconstitution

7. Below knee run off

8. Foot angiogram

9. 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

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

11. Femoropopliteal restenosis

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

22. DEBATE-ISR, 36 months

33. Thank you

34. On going trials
COPA CABANA
ISRA PEBIS
PHOTO PAC

39. Zilver PTX study slide

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