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BackTable / VI / Podcast / Episode #364
Percutaneous Transmural Arterial Bypass (PTAB) as a Treatment Option for CTOs
with Dr. Sean Lyden
In this episode, host Dr. Sabeen Dhand interviews vascular surgeon Dr. Sean Lyden about percutaneous transarterial bypass (PTAB) with DETOUR, a new therapy for treating occlusive / stenotic superficial femoral artery (SFA) disease.
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BackTable, LLC (Producer). (2023, September 11). Ep. 364 – Percutaneous Transmural Arterial Bypass (PTAB) as a Treatment Option for CTOs [Audio podcast]. Retrieved from https://www.backtable.com
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Podcast Contributors
Dr. Sean Lyden
Dr. Sean Lyden is the chairman of vascular surgery and a professor of surgery with Cleveland Clinic in Cleveland, Ohio.
Dr. Sabeen Dhand
Dr. Sabeen Dhand is a practicing interventional radiologist with PIH Health in Los Angeles.
Synopsis
Dr. Sean Lyden serves as the Chairman of Vascular Surgery at Cleveland Clinic. Sean starts off the discussion by conveying the severity of SFA chronic total occlusion (CTO) and walks us through what PTAB therapy is. We then cover the steps and general principles of using the DETOUR technology.
Throughout the episode, Sean and Sabeen discuss the structure and key takeaways of both the DETOUR 1 and DETOUR 2 trials, held in Europe and the United States respectively. They also cover major questions, such as DVT and PE risk, patency of femoral vein following DETOUR intervention, and overall device cost.
We conclude the episode with future directions of the now FDA-approved DETOUR device, and when and how vascular and interventional physicians can incorporate the new technology into their practice. Sean and Sabeen also contrast prior treatment options with the recent DETOUR trials to highlight how longer calcified / occluded SFA lesions now have a viable, effective, and safe endovascular treatment option.
Resources
PTAB with DETOUR System:
https://endologix.com/ptab/detour/
DETOUR 1 Trial:
https://pubmed.ncbi.nlm.nih.gov/29327570/
DETOUR 1 Trial, 1 year follow-up results:
https://pubmed.ncbi.nlm.nih.gov/32276015/
DETOUR 2 Trial, 12 month results:
https://www.jvascsurg.org/article/S0741-5214(22)01274-5/fulltext
DETOUR 2 Trial, 24 month results from Vascular Annual Conference Presentation:
https://www.dicardiology.com/content/endologix-announces-24-month-results-detour-2-study-2023-vascular-annual-meeting
Voyager Trial:
https://www.nejm.org/doi/full/10.1056/nejmoa2000052
Compass Trial:
https://www.nejm.org/doi/full/10.1056/nejmoa1709118
Transcript Preview
[Dr. Sean Lyden]
The easiest way to think of the Detour System is it's a way to create a percutaneous femoral to popliteal bypass. You're going to start in the arterial side, you need basically just enough opening in the origin of the SFA to get a catheter or wire in at least 3 centimeters. Then it uses a spring loading proprietary crossing device which will puncture out of the superficial femoral artery into the femoral vein, and then travel down the femoral vein, and then use that same crossing device to cross back from the femoral vein into the popliteal artery. Then you're basically lining that segment with a PTFE stent graft, usually two or three stent grafts to cover that segment.
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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