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Critical Limb Ischemia (CLI)

Critical Limb Ischemia (CLI) Condition Overview

Learn more on the BackTable VI Podcast

BackTable is a knowledge resource for physicians by physicians. Get practical advice on Critical Limb Ischemia (CLI) and how to build your practice by listening to the BackTable VI Podcast, reading exclusing BackTable Articles, and following the work of our Contributors.

Ep 350 Building a CLI Program with Dr. Zola N’Dandu
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Critical Limb Ischemia (CLI) Podcasts

Listen to leading physicians discuss critical limb ischemia (cli) on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.

Episode #410

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In this episode of BackTable Podcast, host Dr. Ally Behati invites interventional cardiologist Dr. Thomas Davis, Director of the Cardiac Catheterization Lab at St. John Hospital and Medical Center, to discuss re-entry devices, with a focus on the Pioneer Plus Catheter.

Dr. Davis shares his experience in using the Pioneer Plus, an intravascular ultrasound (IVUS) guided re-entry catheter in treating critical limb ischemia (CLI), especially in cases where it is difficult to stay intraluminal. He explains a novel ‘reorientation technique’, which allows proceduralists to remain in the true lumen while treating a chronic total occlusion. Dr. Davis also describes his workflow and decision points about when to reach for the catheter. To finish the episode, he covers post-procedure patient management, imaging follow up, and opportunities to learn more about treatment of peripheral vascular disease.

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Episode #408

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In this episode, host Dr. Aaron Fritts is joined by interventional cardiologists Dr. Sameh Sayfo (Baylor Scott & White in Plano, TX) and Dr. Nicolas Shammas (Cardiovascular Medicine in Davenport, IA) for a discussion about critical limb ischemia (CLI) and the use of lasers in below-the-knee (BTK) treatment.

To start, Dr. Shammas explains that infrapopliteal disease is difficult to treat due to the high rate of total occlusions and the high degree of medial calcinosis. Next, he gives an introduction to laser atherectomy for certain plaque locations and morphologies, and he describes previous studies that have shown its efficacy for calcified lesions. Intravascular ultrasound (IVUS) can also help guide vessel sizing, plaque morphology, and appropriate device selection. Dr. Shammas believes that the current atherectomy devices on the market are easy to learn to use and can be incorporated into any CLI program.

The doctors discuss the ongoing multicenter study on outcomes of the Auryon laser atherectomy system in CLI patients. Dr. Shammas reviews the study design, proposed endpoints, and current data on 30 day outcomes. We end the episode with advice on building a strong CLI program, which includes multidisciplinary collaboration, advocating for resources, a variety of different tools, and appropriate management of cardiovascular risk factors.

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Episode #392

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In this episode of the BackTable Podcast, host Dr. Ally Baheti and Dr. Paramjit “Romi” Chopra discuss the processes involved in successful interventional radiology practice management. Dr. Chopra is an interventional radiologist practicing in Chicago, IL. He is the founder and CEO of Midwest Institute for Minimally Invasive Therapies.

Dr. Chopra advises young IRs against going solo, and he suggests finding people who’ve done it before, to avoid “reinventing the wheel.” Dr. Chopra emphasizes the importance of adopting a patient-centered approach, building systems, developing business sense, and understanding risk. He shares his own experiences of building systems using Salesforce and explains the concept of ‘omni-channel healthcare delivery’. He particularly discusses the importance of patient, provider, and payer relationships, and he offers solutions for dealing with inherent complications. The episode also covers identifying the right electronic health record and developing an effective inventory management system.

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Episode #390

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In this episode of the BackTable Podcast, host Dr. Chris Beck discusses atherectomy, laser technologies, and their use in vessel treatment with Dr. Tony Das, an interventional cardiologist practicing in Dallas, TX and one of the founding members of the VIVA Vascular Education Course in Las Vegas.

Dr. Das shares insights on the PATHFINDER registry, which is a prospective non-randomized, multicenter study to evaluate the performance and outcome of the Auryon laser atherectomy system. Their conversation explores the role of atherectomy in reducing stent usage, decreasing embolization likelihood, enhancing thrombus removal, and uncovering lesions. Dr. Das further provides recommendations for building a successful atherectomy program, utilizing laser technologies, and the importance of having ablative technology in outpatient labs. The doctors forecast future applications for artificial intelligence and remote monitoring.

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Episode #368

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In this episode, host Dr. Aaron Fritts and Dr. Krishna Mannava engage in a discussion with Dr. Bret Wiechmann about a concerning trend in the field—insurance denials for critical limb ischemia (CLI) interventions.

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Episode #350

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In this episode, host Dr. Michael Barraza interviews Dr. Zola N’Dandu, an interventional cardiologist at Ochsner Medical Center in Louisiana, about building a successful critical limb ischemia (CLI) program.

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Episode #336

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In this episode, host Dr. Christopher Beck interviews Dr. Peter Soukas about his algorithm for below the knee (BTK) critical limb ischemia (CLI) interventions as well as his implementation of new evidence-based guidance.

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Episode #334

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In this episode, host Dr. Aaron Fritts interviews Dr. Peter Soukas taking a deep dive into novel balloon technologies, appropriate uses below the knee, and how these new balloons are highly effective in treating patients with critical limb ischemia (CLI). Dr. Soukas explains how new balloon technologies can minimize the risk of dissections (therefore decreasing the need for bailout stents), create effective lumen gain in concentric and eccentric calcified lesions with minimal recoil, and keep pressures low compared to legacy products.

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Episode #331

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In this episode, host Dr. Ally Baheti interviews Jill Sommerset and Dr. Fadi Saab about EVUS and IVUS in peripheral arterial cases, including when to use each, how to train an interventional sonographer, and what adding ultrasound in a case can do for patient safety.

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Episode #315

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In this episode, host Dr. Chris Beck interviews Dr. Alexander Ushinsky about his standard workup and treatment when performing arterial thrombectomy in acute limb ischemia (ALI).

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Episode #294

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In this episode, guest host and vascular technologist Jill Sommerset interviews Dr. Mary Costantino (interventional radiologist) and Dr. Miguel Montero-Baker (vascular surgeon) about their perspectives on an ultrasound-first approach to diagnosing and planning treatment for critical limb-threatening ischemia (CLTI).

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Episode #260

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In this episode, host Dr. Ally Baheti interviews interventional radiologist Dr. Luke Wilkins about his approach to the subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) technique for crossing challenging chronic total occlusions (CTO) in critical limb ischemia (CLI) patients.

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Episode #241

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In this episode, guest host Jill Sommerset interviews vascular surgeon Dr. Miguel Montero-Baker about his evolving use of ultrasound throughout his career in caring for critical limb-threatening ischemia (CLTI) patients.

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Episode #229

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In this episode, guest host and vascular technologist Jill Sommerset interviews interventional radiologist Dr. Mary Costantino about the use of advanced arterial ultrasound in the setting of chronic limb-threatening ischemia (CLTI), especially in pre-procedural mapping.

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Episode #212

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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.

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Episode #200

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We talk with Dr. Luke Wilkins about his stenting algorithm for treating peripheral artery disease, including a step by step discussion of the decision tree when deciding whether or not to stent.

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Episode #edición-esp-02

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En este episodio de BackTable Español, Dra. Gina Landinez entrevista a Dr. Miguel Montero-Baker sobre la enfermidad arterial periférica y salvamento de extremidades en la comunidad latinoamericana.

In this episode of BackTable Español, Dr. Gina Landinez interviews Dr. Miguel Montero about peripheral arterial disease and limb salvage in the Latin American community.

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Episode #181

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Vascular Surgeon Dr. Mazin Foteh and our host Dr. Sabeen Dhand consider various factors that can influence the choice of treatment methods for calcified common femoral artery (CFA) disease, including discussing the pros and cons of an endovascular vs surgical approach.

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Episode #175

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CLI fighters Dr. Kumar Madassery and Dr. Sabeen Dhand discuss their approach to treating calcified arteries below the knee, including looking at newer technologies and choosing the appropriate device to effect real durable change to the calcified wall.

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Episode #172

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CLI fighters Dr. Bryan Fisher and Dr. Sabeen Dhand discuss their approach to treating calcified arteries above the knee, including looking at newer technologies and choosing the appropriate device to effect real durable change to the calcified wall.

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Episode #119

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Interventional Radiologist Sabeen Dhand talks with Vascular Surgeon Bryan Fisher about the benefits of using Intravascular Ultrasound (IVUS) for endovascular treatment of peripheral arterial disease (PAD), as well as the potential for other emerging imaging modalities such as Optical Coherence Tomography (OCT).

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Episode #118

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Interventional Radiologist Dr. Donald Garbett talks with Dr. Michael Barraza about how he approaches acute limb ischemia, including different endovascular techniques for removing acute arterial clot.

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Episode #93

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Interventional Cardiologist Fadi Saab and Interventional Radiologist Sabeen Dhand discuss Percutaneous Deep Venous Arterialization (DVA) for critical limb ischemia (CLI), including workup, technique, and follow-up.

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Episode #90

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Dr. Mary Costantino and Technical Director Jill Sommerset talk technique and utility of using Pedal Acceleration Time for pre- and post-procedure evaluation of CLI patients. They also discuss intra-procedure extravascular ultrasound guidance to aid in safe and effective endovascular interventions.

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Critical Limb Ischemia (CLI) Articles

Read our exclusive BackTable VI Articles for quick insights on critical limb ischemia (cli), provided by physicians for physicians.

BioMimics Stent

Interventional Radiologist Dr. Rundback discusses the BioMimics stent design, when to use it in the femoral popliteal artery, & strategies to increase it's effectiveness in peripheral artery disease.

Supera Stent product image

Interventional Radiologist Dr. Rundback shares his expertise on the Supera Stent along with tips & tricks in deploying it & treating peripheral arterial disease in the femoral popliteal artery.

Calcified popliteal occlusion treated with 5mm Shockwave lithotripsy

Vascular surgeon Dr. Bryan Fisher shares his experiences using Shockwave intravascular lithotripsy to treat lower extremity arterial disease on the BackTable Podcast. Dr. Fisher discusses his treatment algorithm, the unique role of Shockwave lithotripsy, and visualizing technical success following the therapy.

Intravascular ultrasound image of intima, media, and adventitia.

Intravascular ultrasound (IVUS) is a useful method for evaluating vessel stenosis and calcifications. Dr. Bryan Fisher explains how he uses IVUS and intravascular lithotripsy to treat calcified vessels.

Disclaimer: The Materials available on https://www.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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Podcasts

True Lumen Re-Entry with Pioneer Plus with Dr. Thomas Davis on the BackTable VI Podcast)
Laser BTK Study Insights: Navigating Complex Lesions with Dr. Nicolas Shammas on the BackTable VI Podcast)
How to Maximize Efficiency & Revenue with EMRs & Practice Management Systems with Dr. Paramjit "Romi" Chopra on the BackTable VI Podcast)
Laser Atherectomy: An Overview of the Pathfinder Registry with Dr. Tony Das on the BackTable VI Podcast)
The Recent Trend of Insurance Denials for CLI Interventions with Dr. Bret Wiechmann on the BackTable VI Podcast)
Iliofemoral Stenting: Decision-Making & Best Practices Explored with Dr. Kush Desai and Dr. Steven Abramowitz on the BackTable VI Podcast)

Articles

BioMimics Stent

Veryan BioMimics Stent for Femoral Popliteal Disease

Supera Stent product image

Finding Success with the Supera Stent in Femoral Popliteal Disease

Calcified popliteal occlusion treated with 5mm Shockwave lithotripsy

Shockwave Intravascular Lithotripsy Treatment Algorithm & Technical Success

Contributors

Dr. Paramjit Chopra on the BackTable VI Podcast

Dr. Paramjit Chopra

Dr. Tony Das on the BackTable VI Podcast

Dr. Tony Das

Dr. Thomas Davis on the BackTable VI Podcast

Dr. Thomas Davis

Dr. Bryan Fisher on the BackTable VI Podcast

Dr. Bryan Fisher

Dr. Mazin Foteh on the BackTable VI Podcast

Dr. Mazin Foteh

Dr. Donald Garbett on the BackTable VI Podcast

Dr. Donald Garbett

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