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Arterial revascularization is one of the cornerstones to treatment for peripheral arterial disease. These patients and their procedures can range in scope, complexity and level of difficulty. Understanding key concepts will help an interventionist begin to dive into this complex topic.
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• Peripheral vascular disease - including focal or long segment stenoses and/or chronic total occlusions.
• Uncorrectable bleeding diathesis
• Stenotic/occlusive disease with high thromboembolic risk
• Renal failure
• Extreme vessel tortuosity
Things To Check
• History and Physical
• Patient anticoagulation status
• Creatinine, coagulation profile
• Any prior imaging - Vascular ultrasound, CTA, MRA
• Lower extremity pulses
Arterial Revascularization Podcasts
Listen to leading physicians discuss arterial revascularization on the BackTable VI Podcast. Get tips, tricks, and expert guidance from your peers and level up your practice.
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.
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.
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.
Dr. Jim Melton and Dr. Blake Parsons discuss the benefits of retrograde pedal access in the treatment of PAD, as well as the team approach of their outpatient CardioVascular Health Clinic , which includes Vascular Surgery, Interventional Radiology, and Interventional Cardiology working together as partners for better patient care.
• Access common femoral artery of contralateral leg using micropuncture needle under US
• Advance wire centrally
• Place a 5, 6 or 7 Fr sheath (depending on the potential atherectomy device).
• Advance flush catheter over the wire into the aorta.
• Perform AP aortogram - 15 mL/sec for 30 mL.
• Pull flush catheter back into the distal aorta
• Perform iliac artery arteriogram - 10 mL/sec for 20 sec.
• Keep catheter in distal aorta and perform lower extremity runoff arteriography - 8 mL/sec for 80 mL
• Exchange for a selective catheter and catheterize target artery.
• Position catheter proximal to lesion.
• Administer heparin bolus prior to crossing lesion (2500-5000 U)
• Gently advance guidewire across stenosis.
• If resistance is met - avoid dissection and retract wire. Redirect catheter and readvance wire until successful passage.
• Direct guidewire through central canal of lesion. Advance selective catheter over wire across the lesion
• Angiogram following lesion crossing to confirm position
• Exchange crossing guidewire for a 0.014" guidewire.
• Many options from balloon angioplasty to atherectomy
• Introduce atherectomy device over guidewire; perform atherectomy across lesion
• Inject contrast through sheath or catheter to evaluate progress. Determine if further intervention is needed. May need balloon angioplasty, or stent placement if dissection occurs.
• Remove access sheath and close arteriotomy site - closure device or manual pressure.
Arterial Revascularization Articles
Read our exclusive BackTable VI Articles for quick insights on arterial revascularization, provided by physicians for physicians.
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.
Retrograde pedal access is becoming popular among both patients and interventionalists for the treatment of critical limb ischemia and peripheral vascular disease. Vascular surgeon Dr. Jim Melton and interventional radiologist Dr. Blake Parsons discuss IR and vascular surgery collaboration in their practice.
• Supine bedrest for 3 hours with closure device. 6 hours with manual pressure
• Arterial injury - dissection, rupture, hematoma, distal embolization, thrombosis.
• Groin complications
Arterial Revascularization Demos
Watch video walkthroughs of arterial revascularization on the BackTable VI expanded content network.
 Mittleider D, Russell E. Peripheral Atherectomy: Applications and Techniques. Tech Vasc Interv Radiol. 2016;19(2):123‐135. doi:10.1053/j.tvir.2016.04.005
 Wilkins LR, Sabri SS. Strategies to Approaching Lower Limb Occlusions. Tech Vasc Interv Radiol. 2016;19(2):136‐144. doi:10.1053/j.tvir.2016.04.006
 BackTable, LLC (Producer). (2017, August 16). Ep 9 - #StopTheChop [Audio podcast]. Retrieved from https://www.backtable.com/shows/vi
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