registry of PAD by Dr.Ahmed Abdallah Emam under the supervision of prof.Dr.Ayman Saleh

3. PAD:
-Major healthcare issue worldwide.
-Patients with PAD = risk of
mortality, MI and CVS.
-Pressing need to commence an
effective therapeutic strategy for
treating patients with PAD.

4. PAD
•Common.
•Under-diagnosed
•Under-treated.
•Diagnosed accurately with
simple, noninvasive, office-
based tests .

5. REVASCULARIZATION

7. • prospective registry.
• ASU and NHI.
• Symptomatic PAD pts. who
underwent PTA.

8. •The study assessed the influence of
varying factors (baseline clinical,
demographic, and imaging) on the
success rate IMMEDIATELY and 12 ms.
after PTA for symptomatic PAD pts.
It also suggested a standardized
REPORTING TEMPLATE that can be
used for reporting results of studies
relating to peripheral vascular
interventions.

15. Immediate outcome:
Clinical Success : Improvement by at
least on clinical category, & well felt
distal pulsation.
Technical Success : Success to enter
the vessel, cross the lesion, or improve
blood flow.
Clinical and technical success had to be fulfilled to consider the
intervention successful.

20. 100
90.4%
80 73%
66.5% 70%
60 57%
Y
43%
40 33.5% N
27% 30%
20
9.6%
0
DM HTN DYSLIP. Smoking S.Cr. level >
1.5 mg/dl.

21. Type of ischemia TASC
60 56.8% 40 40 %
35
50 43.2% 30 %
30
40 25
30 20
18 %
15 12 %
20
10
10 5
0 0
CLI Claud. A B C D

22. 13.3%
Combined
6.7% 32%
Below knee Above
inguinal
ligament
48% Below
inguinal
ligament;
above knee

24. Mean SD
No. Min Max
Diameter 4.80 1.919
mm.
2 10
Pre stent 138 Length
10.00 80.00 31.254 12.50047
mm.
Balloons Pressure
1 15 8.00 2.656
atm.
No. of inflations 3.47 2.938
1 19*
Diameter 1.171
185 mm.
5 10 7.22
Stents Length
mm.
15 150 69.19 27.734
Pressure 12.20 3.194
atm.
8 17
Diameter 6.47 1.586
2 10
Post stent
121 Length
19 80 37.57 17.693
deployment
Pressure 10.10 2.981
balloons atm.
4 18
No. of inflations 3.05 1.664
1 8*

25. Seven weeks , the patient
reported significant
This patient was
improvement in the
originally advised to
symptoms of claudication .
undergo an above knee
Other than the loss of the
amputation of his right
gangrenous toe, the
foot , which prompted a
patient was walking
second opinion and the
without difficulty and
resulting endovascular
extremely pleased to have
procedure. Ulcerative
been able to avoid the
cellulitis and critical limb
above knee amputation.
ischemia (gangrene) of
Limb salvage was
the fourth toe were
accomplished.
evident.

26. Non-healing ulcers
of the LT & RT foot
that prompted
endovascular
therapy .
Healing ulcer of the RT foot 4
weeks after restored blood
Wound-healing progress was
flow to the plantar surface of
also made on the LT foot.
the foot

27. In Hosp. M. S.D P S
In hosp. M. S.D P S
Factor Mortality Factor morbidity
No 57.8 9.56
8 9 No 58.19 9.437
Age
Yes 68.4 15.0
.042 S Age
Yes 56.00 12.87 .441
NS
0 93 1
No 1.59 .701
No of No 1.61 .693 Number NS
.650 NS Yes 2.00 .535 .074
stents Yes 1.80 .837 of stents
Number No 1.33 .688
Number No 1.36 .715
of Yes 2.00 1.00 .037 S of NS
lesions 0 Yes 1.31 .630 .808
lesions
Cr.>1.5 No 1.18 .353
No 1.18 .305
mg/dl Yes 1.72 .421 .001 HS Cr.>1.5 S
Yes 1.43 .801 .034
mg/dl
No 1.01 1.01
TASC D 7 No 1.09 1.037
.496 NS .013
Yes 1.40 1.32
TASC Yes .38 .650 S
D

28. In hospital mortality
P. Sig.
No Yes
% within In
DM No hospital
mortality
34.7% .0%
.046 S
% within In
Yes hospital 65.3% 100.0%
mortality
In hospital morbidity
No Yes
% within In
DM No hospital
morbidity
35.3% 15.4%
.146 NS
% within In
Yes hospital 64.7% 84.6%
morbidity

30. Alive
SCD
Others
Leg gangrene
Alive 84% Dead 16%

31. No symptoms
85 %
recurrence
10 %
Symptoms 4%
1%
recurrence
0 20 40 60 80 100
Claudication CLI Acute limb ischemia

32. One year follow up criteria Value %
Patient state:
Alive 84.0
Dead 16.0
cause of death:
Leg gangrene 3.0
Sudden cardiac death 12.0
Others 1.0
Recurrence of LL symptoms 15
Site of recurrence responsible for symptoms:
Target lesion 7
Other lesion 8
Type of ischemia:
Claudication 10
CLI 4
Acute 1
Management of patients with recurrence of LL
symptoms:
Endovascular 10.3
Surgical 5.1
Medical ttt 84.6

33. Factor Patient Mean Std. Deviation P Sig.
state
Alive 57.12 9.862
Age .021 S
Dead 63.50 10.752
Alive 1.60 .746
No of stents .929 NS
Dead 1.63 .744
Alive 1.30 .576
Number of Dead 1.38 .619 .628 NS
lesions
Alive 1.24 .422
Creatinine >1.5 Dead 1.18 .274 .555 NS
mg/dl
Alive 1.06 1.068
TASC D .469 NS
Dead 1.21 1.122

35. Variant Factor P value Sig.
Smoking 0.02 S
Hypertension 0.05 S
Affected LL +ve Family history 0.028 S
(single,
bilateral) Number of lesions .0001 HS
Age .0001 HS
.039
Creatinine >1.5 mg/dl S
Hypertension 0.001 HS
Dyslipidemia
DM Lesion
Calcification
0.043
0.005
S
HS
Long lesion 0.024 S
S
In hospital mortality 0.046

38. -Dramatic shifts in the management of
PVD have occurred toward
endovascular intervention.
-There seems to be a significant M&M
advantages for endovascular as
compared to surgery.
-The increasing safety of vascular
interventions should be considered with
the caveat that INDEPENDENT
FACTORS OF OUTCOMES SHOULD BE
RESPECTED.

39. •Endovascular ttt is not without
possible in-hospital mortality.
•Endovascular revascularization
is a good palliative ttt for CCLI
with a recurrence rate of 15 %
(only 4 % recurrence of CCLI).

40. •Interestinglylimb salvage
was 100% in this series .
•The need for urgent
surgical revascularization
was 1.3 %.

41. Case reporting by
interventionists
needs to be
improved and
unified.

43. •Improving the identification of
pts with symp. PAD. By ensuring
that physicians are well informed
about PAD prevention, detection,
and management.
•An endovascular approach should
be tailored based on a patient’s
comorbidities and anatomical
factors.