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Cardiology
Peripheral Arterial Intervention of the Upper and Lower Extremities
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 123 slides
Overview
- Scope of this presentation
Disease burden and arterial anatomy
- Burden of peripheral arterial disease
- Causes of peripheral arterial disease
- Plaque distribution and shear stress
- External compressive forces in the lower limb
- Femoropopliteal points of bend and compression
- Lesions at a major bifurcation
- Subclavian stenosis: definition and collaterals
- Subclavian steal syndrome
- Upper extremity ischaemic symptoms
- Indications for subclavian intervention
- Exceptions: asymptomatic subclavian stenosis
- Choosing endovascular versus surgery in subclavian disease
- Aortoiliac disease: revascularisation strategy
- Access site selection in ostial common iliac disease
- Preservation of the internal iliac artery
- Internal iliac coiling and type II endoleak
- Aortoiliac disease extending into the common femoral artery
- Common femoral artery: mechanical environment
- Profunda femoris origin and collateral supply
- Guideline recommendations for common femoral disease
- Course of the superficial femoral artery
- Treating the proximal superficial femoral artery
- Stenting across the adductor hiatus
- Popliteal artery
- Infrapopliteal arteries
- Segment-specific device environment
Fundamentals and indications
- Wire platforms in peripheral intervention
- Access sites for peripheral intervention
- Indications for upper extremity revascularisation
- Asymptomatic lower extremity disease
- First-line management of claudication
- Thresholds for lower extremity revascularisation
- Escalation from diagnosis to revascularisation
Equipment by arterial segment
- Access and sheaths for subclavian intervention
- Telescoping technique for stenotic subclavian lesions
- Subclavian chronic total occlusion and stent choice
- Cerebral embolic protection in subclavian intervention
- Subclavian stenosis before and after stenting
- Angioplasty versus stenting in aortoiliac disease
- The ICE trial
- Choosing stent type by iliac location
- Drug-eluting technology in the aortoiliac segment
- Covered stents in iliac disease
- Bilateral common iliac stenosis treated with kissing stents
- Common femoral artery: surgical default
- Endovascular outcomes in the common femoral artery
- The TECCO trial
- Plain angioplasty in the femoropopliteal segment
- Drug-coated balloons in the femoropopliteal segment
- The paclitaxel mortality controversy
- Serration balloon angioplasty
- In-stent restenosis of the superficial femoral artery
- Stenting after femoropopliteal angioplasty
- Bare and drug-eluting self-expanding stents
- Covered stents and dissection repair in the thigh
- Infrapopliteal equipment and plain angioplasty
- Drug-coated balloons below the knee
- Serration angioplasty below the knee
- Stents below the knee
- The LIFE-BTK trial
- Anterior tibial occlusion treated with serration angioplasty
Calcium modification and intravascular imaging
- Mechanisms of atherectomy
- Rotational atherectomy devices
- Directional atherectomy
- The TALON registry
- Orbital atherectomy
- Laser atherectomy
- Intravascular lithotripsy
- The Disrupt PAD III trial
- Limitations of angiography
- Intravascular ultrasound: principles
- Optical coherence tomography: principles
- Evidence for intravascular imaging in the leg
- Current recommendations on IVUS use
Clinical presentation
- Presentation of subclavian stenosis
- Special upper extremity presentations
- Spectrum of lower extremity symptoms
- Rutherford-Becker and Fontaine classifications
- Intermittent claudication
- Revascularisation for lifestyle-limiting claudication
- Asymptomatic peripheral arterial disease
- Chronic limb-threatening ischaemia
- Goals of revascularisation in CLTI
Work-up, management and follow-up
- Outpatient risk factor modification
- Antithrombotic therapy in symptomatic PAD
- Cilostazol
- Ankle-brachial index
- Non-compressible vessels and the toe-brachial index
- Duplex ultrasound
- Exercise testing and cross-sectional angiography
- Deferring angiography to the procedure
- Procedural planning and the vascular team
- Surveillance after revascularisation
- Detecting restenosis and treatment failure
- Antithrombotic therapy after endovascular treatment
- Ongoing cardiovascular surveillance
- Limitations of endovascular therapy
- Burden of reintervention
- No-option chronic limb-threatening ischaemia
- Deep vein arterialisation: technique
- The PROMISE II trial
- Direction of travel in peripheral intervention
- Key points
- References
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- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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