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

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

3. Tasc II Definitions

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

5. 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

6. 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

7. 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

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

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

10. Cryovein
Cryopreserved cadaveric vein
Patency % 1-3 yrs

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

15. 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

19. 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 % in the BK position

24. 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

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

26. 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