BackTable / VI / Podcast / Episode #212

New Tools to Treat Severe Distal Femoropopliteal Disease

with Dr. John Rundback

In this episode, host Dr. Sabeen Dhand interviews Dr. John Rundback, interventional radiologist, about distal femoropopliteal disease, including the unique pathophysiology of this area, which stents work best at the adductor canal and the trifurcation, and tips for early operators.

Sponsored by:

Veryan BioMimics 3D® Vascular Stent System
New Tools to Treat Severe Distal Femoropopliteal Disease with Dr. John Rundback on the BackTable VI Podcast)
Ep 212 New Tools to Treat Severe Distal Femoropopliteal Disease with Dr. John Rundback
00:00 / 01:04

BackTable, LLC (Producer). (2022, May 30). Ep. 212 – New Tools to Treat Severe Distal Femoropopliteal Disease [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. John Rundback discusses New Tools to Treat Severe Distal Femoropopliteal Disease on the BackTable 212 Podcast

Dr. John Rundback

Dr. John Rundback is a practicing Vascular Interventional Radiologist at AIVS LLP in the New York City area.

Dr. Sabeen Dhand discusses New Tools to Treat Severe Distal Femoropopliteal Disease on the BackTable 212 Podcast

Dr. Sabeen Dhand

Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.

Show Notes

In this episode, host Dr. Sabeen Dhand interviews Dr. John Rundback, interventional radiologist, about distal femoropopliteal disease, including the unique pathophysiology of this area, which stents work best at the adductor canal and the trifurcation, and tips for early operators.

We begin by discussing peripheral arterial disease (PAD) pathophysiology, specifically in the challenging areas around the adductor canal (Hunter’s canal). Dr. Rundback describes how the femoral artery has twists and turns around this area and that it can experience compressive forces up to 15-20% during motions such as flexion of the knee. Due to this being the most dynamic location of the femoral artery, this is often where plaque rupture will happen, resulting in critical limb ischemia (CLI) and requiring urgent intervention.

The two discuss how traditional rigid stents do not work well in this area due to the dynamic nature of the region and the fact that the artery is tortuous and can cause rigid stents to fracture or cause intimal hyperplasia due to turbulent flow. Drug coated balloon (DCB) angioplasty generally does not work for this region due to poor durability. They discuss the utility of the Tack device, a scaffold with minimal metal which is better suited for focal dissections. Dr. Rundback emphasizes the importance of intravascular ultrasound (IVUS) during all distal femoropopliteal cases due to the complexity of the region and patient-to-patient variation. He uses IVUS to choose which device and what size to use because measuring on angiography is not accurate in these cases.

Finally, they discuss the Supera and BioMimics stents, including the indications, benefits, and ease of deployment of each. Dr. Rundback says that Supera, a woven nitinol stent, gives it the benefit of thermal memory. The difficulty with this stent is the need for aggressive vessel preparation and plaque modification, generally requiring lengthy angioplasty and possibly atherectomy. The BioMimics stent can rotate, curve, and shorten, which is optimal for this region to maintain swirling or helical blood flow rather than causing turbulent flow. The BioMimics stent is also very easy to deploy, and Dr. Rundback generally chooses this stent in locations where he can’t adequately prep the vessel.

Resources

Transcript Preview

[Dr. John Rundback]:
So the biomimic stent has this sort of central line, long it's a configuration and therefore, and there are great videos of this, as the biomechanics change in just let's say pop region it's made to accommodate. It kind of rotates and curves and foreshortens, to really match what's happening physiologically in the individual. And as a result, you kind of maintain, they say swirling flow, but I kind of think of lamina or parabolic flow. And we all know that that's key. You know, if you get turbulent flow that's when you get, PMN rolling and all these other things, which lead to that phenotypic change in the smooth muscle cells and intimal hyperplasia. But if you can maintain this swirling laminar flow or parabolic flow pattern that, in and of itself, is antiproliferative leads to the formation of a conflict endothelium. So the structure itself promotes good healing and prevents intimal hyperplasia.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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Articles

BioMImics Stent

Deploying the BioMimics Stent in Femoral Popliteal Disease: Who, When, How?

Supera Stent product image

Finding Success with the Supera Stent in Femoral Popliteal Disease

Topics

Arterial Stenting Procedure Prep
Atherectomy Procedure Prep
Critical Limb Ischemia (CLI) Condition Overview
Peripheral Artery Disease Condition Overview

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