Notes
Outline
Infrainguinal Disease ‘Up North’
                 NCVH 2006
Raj Dave, MD, FACC, FSCAI
Chairman, Endovascular Medicine
Pinnacle Heart and Vascular Institute
Harrisburg, PA
About This presentation:
Not driven by hard core data
Based on techniques & Lessons learned from >3000 vascular PCI
Complex Lower Extremity Revascularization
70 yom with Rest pain of LLEx
Prior Fem pop Graft, total occlusion
Severe CAD and Angina
No option for surgery
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Final Results: Walking Next Day
Claudicant
58 yom, DM, prior smoking
Mail Man
2004: Lt SFA CTO, Subintimal Recanlization and SMART stents
2006: Recurrent symptoms with Follow up doppler, LT SFA TO
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Why Laser?
Excellent Debulking capacity with new Turbo Line
Thrombectomy & Atherectomy “All In One”
Minimal Risk of embolization
No embolic protection device necessary
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Summary
Laser excellent choice for ISR
Viabahn improves secondary patency in Failed Nitinol stent
Correct Inflow and outflow
IVUS may aid in improving outcomes of ISR
Claudicant
75 yom
CAD, DM, HTN
Popliteal occlusion and diffuse disease in SFA
Two attempts at endovascular treatment at outside institution failed
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Conclusion
Relief of symptoms
Plays Nine holes of Golf
Doppler follow up: Patent SFA/POP
Message; Correct INFLOW AND OUTFLOW BOTH
Acute Limb Ischemia
70yof IDDM, Hyperlipidemia, Smoker
Aug 06: Claudication
Treatment: 8/06: Laser and PTA Rt SFA/POP
10/06: Return with RT Foot Pain, ABI 0.2
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Conclusion:
Complete relief of symptoms
Palpable pulse at the end of procedure
Flexible stents such as Flexstar, Everflex and Viabahn has improved outcomes and reduced fractures at Extreme bending points
50 yof Landscaper
Severe Claudication
Vasc Surg Consult: Recommend surgery
Referred for endovascular intervention
Angiogram
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