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Biondi-Zoccai: Peripheral interventions – metcardio.org Basic principles of peripheral interventions Giuseppe Biondi Zoccai University.

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Presentation on theme: "Biondi-Zoccai: Peripheral interventions – metcardio.org Basic principles of peripheral interventions Giuseppe Biondi Zoccai University."— Presentation transcript:

1 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org Basic principles of peripheral interventions Giuseppe Biondi Zoccai University of Turin, Turin, Italy gbiondizoccai@gmail.com Educational Fellowship Course In PCI For Young Interventionalists Session 2 - How do I treat: Case based discussion 22 October 2009 – 16:35-16:47

2 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org DISCLOSURE I am giving a lecture at a Fellows’ Course

3 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS Why peripheral interventions are important for everybody General approach What is similar and what is different between coronary and peripheral arteries District-specific tips & tricks

4 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS Why peripheral interventions are important for everybody General approach What is similar and what is different between coronary and peripheral arteries District-specific tips & tricks

5 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org WHY SO IMPORTANT? PAD is often present in patients with established CAD PAD may be the first and/or only manifestation of atherothrombosis in several pts Peripheral complications during PCI or other cardiac interventions are not rare and should best be managed by YOU in the cath lab

6 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS Why peripheral interventions are important for everybody General approach What is similar and what is different between coronary and peripheral arteries District-specific tips & tricks

7 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org A GLOBAL MANAGEMENT APPROACH IS A MUST

8 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org TAKE CARE AT PREPPING

9 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org ALWAYS BEGIN YOUR TRAINING AND YOUR SINGLE PROCEDURE WITH A GOOD QUALITY ANGIO

10 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org IMAGING WITH DSA IS A MUST FOR ALL VESSELS < 5.0 MM

11 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org MINIMIZE RADIATION RISK 2 MONTHS AFTER PROCEDURE 6 MONTHS AFTER PROCEDURE 2 YEARS AFTER PROCEDURE

12 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS Why peripheral interventions are important for everybody General approach What is similar and what is different between coronary and peripheral arteries District-specific tips & tricks

13 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org Garcia et al, Catheter Cardiovasc Interv 2009;74:27-36 COMMON ACCESS SITES FOR PERIPHERAL=FOR CORONARY

14 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org Garcia et al, Catheter Cardiovasc Interv 2009;74:27-36 LESS COMMON ACCESS SITES FOR PERIPHERAL≠FOR CORONARY

15 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org DEVICE TYPES ARE ALSO BROADLY SIMILAR Sheaths Shuttle sheaths Guidewires Balloons Stents Filters Thrombectomy catheters

16 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org BUT DEVICE SIZES AND FEATURES ARE VERY DIFFERENT! Sheaths (3-9 Fr) Shuttle sheaths (30-90 cm) Guidewires (0.014”, 0.018”, 0.035”) Balloons (1.25-15.0 mm) Stents (balloon-, self-expandable) Filters Thrombectomy catheters (4-6 Fr)

17 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org 2.0-4.0 5.0-7.0 4.0-7.0 4.0-6.0 6.0-9.0 5.0-9.0 5.0-7.0 7.0-10.0 6.0-8.0 2.0-4.0 5.0-7.0 3.0-5.0 SIZE MATTERS!

18 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org LEARNING GOALS Why peripheral interventions are important for everybody General approach What is similar and what is different between coronary and peripheral arteries District-specific tips & tricks

19 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org RENAL ARTERY STENOSIS

20 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org RENAL ARTERY STENOSIS

21 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org LOWER-LIMB INTERVENTIONS: TASC II 2007 vs. TASC 2000

22 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org IMPORTANCE OF SUBINTIMAL ANGIOPLASTY FOR LOWER-LIMB PTA

23 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org BTK PTA: TOOLS OF THE TRADE Biondi-Zoccai et al, J Endovasc Ther 2009

24 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org ENDOVASCULAR ANEURYSM REPAIR

25 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org CAROTID ARTERY STENOSIS

26 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org CAROTID ARTERY STENOSIS

27 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org CAROTID ARTERY STENOSIS McDonald et al, Stroke 2009

28 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org McDonald et al, Stroke 2009 What about stroke?

29 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org TAKE HOME MESSAGES

30 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org TAKE HOME MESSAGES Peripheral intervention skills must be mastered by all interventional cardiologists for bail-out indications Motivated interventionists can pursue further improvements by focusing on district-specific indications, anatomy, and devices No other specialist beats an experienced cardiologists in peripheral interventions

31 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org Thank you for your attention For any correspondence: gbiondizoccai@gmail.com For these and further slides on these topics feel free to visit the metcardio.org website: http://www.metcardio.org/slides.html gbiondizoccai@gmail.com http://www.metcardio.org/slides.html gbiondizoccai@gmail.com http://www.metcardio.org/slides.html

32 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org ABSTRACT Cardiovascular specialists care for patients with cardiovascular disease which is often extensive and not localized in a single anatomic district. Thus, even interventional cardiologists should have a working knowledge of the indications, contraindications, general principles and specific techniques required for safe and succcessful peripheral interventions. Notwithstanding the need to overcome the limitations of angiographic luminology, a thorough knowledge of a single patient vascular anatomy, proficiency in obtaining vascular access, and availability of dedicated devices, paying attention in particular to device size and shaft length, are pivotal. This presentation offers a brief but comprehensive viewpoint on the basic principles that should be followed by interventional cardiologists willing to begin a peripheral intervention program.

33 Biondi-Zoccai: Peripheral interventions gbiondizoccai@gmail.com – metcardio.org MULTIPLE CHOICE QUESTIONS Question 1- Which of the following accesses is inappropriate for the corresponding target vessel: a) right axillary artery for right carotid stenting; b) antegrade left femoral artery for left posterior tibial angioplasty; c) left radial artery for left renal stenting; d) retrograde right femoral access for left common iliac stenting; e) antegrade right femoral access for right superficial femoral angioplasty. Question 2 - Which of the following peripheral interventional procedures would you consider not clinically indicated: a) right carotid stenting in a symptomatic patient with a 60% stenosis of the right internal carotid artery; b) left popliteal artery angioplasty in a patient with severe claudication and 75% stenosis of the left popliteal artery; c) left renal artery stenting in a non-hypertensive patient with 95% stenosis of the left renal artery; d) endovascular aneurysm repair in an asymptomatic patient with a 60-mm abdominal aorta aneurysm; e) left posterior tibial angioplasty in a patient with a left heel ischemic ulcer and focal occlusion of the posterior tibial artery.

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