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Evolving Strategies in the Treatment of Peripheral Vascular Disease

Evolving Strategies in the Treatment of Peripheral Vascular Disease. Ravish Sachar MD, FACC Wake Heart and Vascular. Disclosures. Educational Grants: Boston Scientific, Abbott Vascular, ev3 Consultant: Abbott Vascular, ev3 Speakers Bureau: Boston Scientific , Abbott Vascular.

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Evolving Strategies in the Treatment of Peripheral Vascular Disease

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  1. Evolving Strategies in the Treatment of Peripheral Vascular Disease Ravish Sachar MD, FACC Wake Heart and Vascular

  2. Disclosures • Educational Grants: Boston Scientific, Abbott Vascular, ev3 • Consultant: Abbott Vascular, ev3 • Speakers Bureau: Boston Scientific, Abbott Vascular

  3. Atherosclerosis Common Etiology • 30-60% of pts with PVD have carotid disease • 50-60% of pts with carotid disease have coronary disease • 10% of pts with coronary disease have carotid disease

  4. Results of Coronary Angiograms in 634 Patients with PAD 8.5%

  5. Patient Survival by ABI . Newman et al ATVB 1999;19; 538-545

  6. Five year mortality ratesPVD versus Cancer *Criqui M. Presentation: Vascular Medicine of the Lower Extremities at the American Diabetes Association’s Scientific Sessions June 1999

  7. PVD ….What are the goals? • Asymptomatic – treat risk factors • Claudication – medical therapy or revascularization to improve symptoms • Critical Limb Ischemia – prevent amputation and limb loss

  8. Goal…Prevention of Amputation

  9. Diagnosis • Non-invasive • Bedside Ankle-Brachial Index • Lower extremity Segmental Pressures and PVRs • Arterial Duplex imaging • MRA • CTA • Invasive • Angiograpy

  10. Magnetic Resonance Angiography

  11. Disease Patterns Non-Diabetics Diabetics

  12. Aorto Iliac Disease

  13. SFA Disease

  14. SFA OCCLUSION

  15. post pre

  16. Subintimal Angioplasty

  17. Reentry Catheters • Outback • Pioneer

  18. SFA – PTA/Stenting Post

  19. Knee Flexion Problems with SFA Stenting…. Knee Extension

  20. With Knee Flexion

  21. 3. Extension / Contraction 1. 2. Flexion Torsion 4. Compression Forces Exerted on Stents in SFA

  22. Type III Type I Type II Type IV

  23. Directional Atherectomy

  24. Directional Atherectomy

  25. Atherectomy

  26. Before After Directional Atherectomy

  27. Orbital Atherectomy

  28. Rotational Atherectomy

  29. Laser Atherectomy

  30. Conclusions • Peripheral Vascular Disease is very prevalent in patients with cardiac disease • PVD is underdiagnosed and undertreated • High Mortality with PVD – usually due to cardiac causes • There are many revascularization options available to patients to improve quality of life

  31. Thank You!

  32. Thank You!

  33. Patient Preference Percutaneous Surgical

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