Endovascular Live Case Mount Sinai Hospital NY 012418

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

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

Exam, Labs, Medications • left DP and PT (doppler) • ABI: Right – 0. 89, Left- 0. 77 • • Hb- 13. 1 g% Platelets- 183 k INR- 1. 0 Creatinine- 1. 4 • Medications: Aspirin, Plavix, Simvastatin, Cilostazol

Inflow

Left leg run off

DSA – CFA bifurcation

Strategy • Right groin access • 7 F, 45 cm cross over Terumo destination sheath • Cross with spartacore wire • Embosheild NAV 6 filter • Directional atherectomy • Drug coated balloon angioplasty • Bail out stenting for flow limiting dissection, perforation

CFA anatomy Diameter Length Bifurcation anatomy

CFA bifurcation variants

TASC II classification

SCAI 2014 guidelines

2016 AHA/ACC PAD guidelines

CFA endarterectomy

CFA endarterectomy

Endovascular treatment of atherosclerotic CFA disease

Patient characteristics

Kaplan-Meir TLR free proportion

Stented vs non stented

Atherectomy vs PTA

CFA –nitinol stents

CFA- nitinol stents

CFA covered stents

CFA-covered stent

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

CFA-CFV

CFA-CFV overlap