1. Endovascular Live Case Mount Sinai Hospital, NY
01/24/18

2. History
81 year old, male
Type 2 DM, hypertension,dyslipidemia, CAD, PAD, CKD
Claudication x 3 months (<1/2 block, left>right). Rutherford category 3

3. Exam,Labs, Medications left DP and PT (doppler)
ABI: Right – 0.89, Left- 0.77
Hb g%
Platelets- 183 k
INR- 1.0
Creatinine- 1.4
Medications: Aspirin,Plavix, Simvastatin, Cilostazol

4. Inflow

5. Left leg run off

6. DSA – CFA bifurcation

7. Strategy Right groin access
7F, 45 cm cross over Terumo destination sheath
Cross with spartacore wire
Embosheild NAV6 filter
Directional atherectomy
Drug coated balloon angioplasty
Bail out stenting for flow limiting dissection, perforation

8. CFA anatomy
Diameter
Length
Bifurcation anatomy

11. CFA bifurcation variants

12. TASC II classification

13. SCAI 2014 guidelines

14. 2016 AHA/ACC PAD guidelines

15. CFA endarterectomy

16. CFA endarterectomy

17. Endovascular treatment of atherosclerotic CFA disease

18. Patient characteristics

19. Kaplan-Meir TLR free proportion

20. Stented vs non stented

21. Atherectomy vs PTA

26. CFA –nitinol stents

27. CFA- nitinol stents

28. CFA covered stents

29. CFA-covered stent

30. Summary
Endarterectomy should be considered as the first line treatment of CFA disease
Endovascular Rx provides a viable option in non-surgical cases
Atherectomy> PTA
Drug coated balloon
Stent- bailout
Covered stent- emergencies

31. CFA-CFV

32. CFA-CFV overlap